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Mszar R, Katz ME, Grandhi GR, Osei AD, Gallo A, Blaha MJ. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep 2024:10.1007/s11883-024-01202-w. [PMID: 38662272 DOI: 10.1007/s11883-024-01202-w] [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] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography. RECENT FINDINGS Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk. Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miriam E Katz
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Gowtham R Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Albert D Osei
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Antonio Gallo
- Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, APHP, INSERM UMR1166, Hôpital Pitié-Salpètriêre, Sorbonne Université, Paris, France
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Nasir K, Mszar R, Cainzos-Achirica M, Grandhi GR, Tromp TR, Alonso R, Bittencourt MS, Bruckert E, Díaz-Díaz JL, Gallo A, Hovingh GK, Miname MH, Muñiz-Grijalvo O, Pang J, de Isla LP, Sijbrands EJ, Watts GF, Mata P, Santos RD. Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study. Am J Prev Cardiol 2024; 17:100611. [PMID: 38125206 PMCID: PMC10730992 DOI: 10.1016/j.ajpc.2023.100611] [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: 01/24/2023] [Revised: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1-100, 101-400, >400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1-100, 160 (16%) had CAC 101-400, and 99 (10%) had CAC >400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1-100 (8% [n = 15] vs 18% [n = 26]), CAC 101-400 (32% [n = 22] vs 40% [n = 36]), and CAC >400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50-59 years were less likely to have obstructive CAD in CAC >400 (55% [n = 6] vs 70% [n = 19]). Conclusion In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.
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Affiliation(s)
- Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Gowtham R. Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Tycho R. Tromp
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Márcio S. Bittencourt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Eric Bruckert
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - José Luis Díaz-Díaz
- Complejo Hospitalario Universitario, Hospital Abente y Lago, A Corūna, Spain
| | - Antonio Gallo
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - G. Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Marcio H. Miname
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | | | - Jing Pang
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Leopoldo Perez de Isla
- Cardiology Department, Hospital Clinico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Eric J.G. Sijbrands
- Department of Internal Medicine, Section Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerald F. Watts
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Raul D. Santos
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Mszar R, Mszar E. Familial Hypercholesterolemia and Our Family's Heart History: From Atherosclerosis and Angina to Awareness and Advocacy. Circ Cardiovasc Qual Outcomes 2024; 17:e010864. [PMID: 38357792 DOI: 10.1161/circoutcomes.124.010864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M.)
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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Cartmel B, Li F, Zhou Y, Gottlieb L, Lu L, Mszar R, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Risch HA, Irwin ML. Randomized trial of exercise on cancer-related blood biomarkers and survival in women with ovarian cancer. Cancer Med 2023; 12:15492-15503. [PMID: 37269192 PMCID: PMC10417064 DOI: 10.1002/cam4.6187] [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: 10/13/2022] [Revised: 04/13/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND In randomized trials in women with breast cancer, exercise has been shown to have beneficial effects on cancer-related circulating biomarkers that may impact survival. Such studies are lacking for ovarian cancer. METHODS This secondary analysis of a published randomized controlled trial examined the impact of a 6-month exercise intervention versus attention-control on change in prespecified circulating biomarkers (cancer antigen 125 (CA-125), C-reactive protein (CRP), insulin-like growth factor-1(IGF-1), insulin and leptin) in a subset of participants who provided a fasting blood draw (N = 104/144) at enrollment and at 6 months. Change in biomarkers between study arms was compared using a linear mixed effects model analysis. An exploratory analysis of the exercise intervention versus attention-control on all-cause mortality included all (N = 144) participants. All statistical tests were two-sided. RESULTS Participants included in the biomarker analysis were 57.0 ± 8.8 (mean ± SD) years old and 1.6 ± 0.9 years post-diagnosis. Adherence to the exercise intervention was 176.4 ± 63.5 min/week. Post intervention IGF-1 (group difference in change: -14.2 (-26.1 to -2.3) ng/mL (least squared means (95% CI))) and leptin (-8.9 (-16.5 to -1.4) ng/mL) were significantly reduced in the exercise group (N = 53) compared to those in attention-control (N = 51). No group difference in change was seen for CA-125 (p = 0.54), CRP (p = 0.95), or insulin (p = 0.37). With median follow-up of 70 months [range 6.6-105.4 months], 50/144 (34.7%) (exercise group; 24/74 (32.4%) versus attention-control group; 26/70 (37.1%)) participants died with no between group difference in overall survival (p = 0.99). CONCLUSIONS Further studies are needed to determine the clinical significance of exercise-induced changes in cancer-related circulating biomarkers in women with ovarian cancer.
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Affiliation(s)
- Brenda Cartmel
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Fang‐yong Li
- Department of BiostatisticsYale School of Public HealthNew HavenConnecticutUSA
| | - Yang Zhou
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Linda Gottlieb
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Lingeng Lu
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Reed Mszar
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Maura Harrigan
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Jennifer A. Ligibel
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Radhika Gogoi
- Gynecologic Oncology, Women and Children's InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Present address:
Department of Obstetrics & GynecologyWayne State UniversityDetroitMichiganUSA
| | - Peter E. Schwartz
- Yale Cancer CenterNew HavenConnecticutUSA
- Section of Medical Oncology, Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Harvey A. Risch
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Melinda L. Irwin
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
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Mszar R, Friedman DJ, Ong E, Du C, Wang Y, Zeitler EP, Cunningham SD, Akar J, Curtis JP, Freeman JV. Sex-based differences in atrial fibrillation ablation adverse events. Heart 2023; 109:595-605. [PMID: 36104219 DOI: 10.1136/heartjnl-2022-321192] [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: 04/01/2022] [Accepted: 08/24/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Older, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF. METHODS In this observational cohort study, we evaluated those enrolled in the National Cardiovascular Data Registry AFib Ablation Registry between January 2016 and September 2020. Using logistic regression, we analysed the association between patient sex and in-hospital adverse events. RESULTS Among 58 960 adults (34.6% women) from 150 centres undergoing AF ablation by 706 physicians, women were older (68 vs 64 years, p<0.001), had more comorbidities, and had lower AF-related quality of life at the time of ablation (mean Atrial Fibrillation Effect on QualiTy-of-life Questionnaire) score: 51.8 vs 62.2, p<0.001). Women had a higher risk of hospitalisation >1 day (adjusted OR (aOR) 1.41 (95% CI 1.33 to 1.49)), major adverse event (aOR 1.60 (95% CI 1.33 to 1.92)) and any adverse event (aOR 1.57 (95% CI 1.41 to 1.75)). Women had a higher risk of bradycardia requiring pacemaker, phrenic nerve damage, pericardial effusion, bleeding and vascular injury, but had no differences in death or acute pulmonary vein isolation. CONCLUSIONS Among almost 60 000 patients in the largest prospective registry of AF ablation procedures, female sex was independently associated with a higher risk of hospitalisation >1 day, adverse events, and reduced quality of life, although there were no differences in death or acute pulmonary vein isolation.
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Affiliation(s)
- Reed Mszar
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Daniel J Friedman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Emily Ong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chengan Du
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Emily P Zeitler
- Department of Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, Pennsylvania, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Joseph Akar
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James V Freeman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Agha AM, Pacor J, Grandhi GR, Mszar R, Khan SU, Parikh R, Agrawal T, Burt J, Blankstein R, Blaha MJ, Shaw LJ, Al-Mallah MH, Brackett A, Cainzos-Achirica M, Miller EJ, Nasir K. The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:1745-1757. [PMID: 36202453 DOI: 10.1016/j.jcmg.2022.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/07/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. OBJECTIVES The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). METHODS The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. RESULTS In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). CONCLUSIONS Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a "gatekeeper" for more advanced imaging among patients presenting with CP.
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Affiliation(s)
- Ali M Agha
- Baylor College of Medicine, Houston, Texas, USA
| | - Justin Pacor
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Reed Mszar
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Roosha Parikh
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Tanushree Agrawal
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeremy Burt
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Verma H, Javed Z, Hong JC, Mahajan S, Mszar R, Grandhi GR, Desai NR, Virani SS, Javed U, Valero-Elizondo J, Nasir K. The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status. Popul Health Manag 2022; 25:669-676. [PMID: 36067118 DOI: 10.1089/pop.2021.0337] [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] [Indexed: 11/13/2022] Open
Abstract
Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.
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Affiliation(s)
- Hannah Verma
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jonathan C Hong
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Salim S Virani
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Umair Javed
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Cainzos-Achirica M, Quispe R, Mszar R, Dudum R, Al Rifai M, Erbel R, Stang A, Jöckel KH, Lehmann N, Schramm S, Schmidt B, Toth PP, Rana JS, Lima JAC, Doria de Vasconcellos H, Lloyd-Jones D, Joshi PH, Ayers C, Khera A, Blaha MJ, Greenland P, Nasir K. Coronary Artery Calcium Score to Refine the Use of PCSK9i in Asymptomatic Individuals: A Multicohort Study. J Am Heart Assoc 2022; 11:e025737. [PMID: 35943062 PMCID: PMC9496288 DOI: 10.1161/jaha.122.025737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The value of coronary artery calcium (CAC) in the allocation of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitors) among individuals without clinically evident atherosclerotic cardiovascular disease (ASCVD) is unknown for indications that do not require confirmed familial hypercholesterolemia. We aimed to assess the ability of CAC to stratify ASCVD risk under 3 non–familial hypercholesterolemia PCSK9i allocation paradigms. Methods and Results We included participants without clinically evident ASCVD from MESA (Multi‐Ethnic Study of Atherosclerosis), CARDIA (Coronary Artery Risk Development in Young Adults) study, DHS (Dallas Heart Study), and HNR (Heinz Nixdorf Recall) study. Three PCSK9i eligibility scenarios were defined: a broad scenario informed only by high low‐density lipoprotein cholesterol levels (N=567), a restrictive one combining higher low‐density lipoprotein cholesterol levels and presence of ≥2 additional risk factors (N=127), and a high‐risk scenario where individuals with subclinical organ damage or high estimated risk would be treated to achieve low‐density lipoprotein cholesterol <55 mg/dL (N=471). The high‐risk scenario had the highest ASCVD event rates (27.8% at 10 years). CAC=0 was observed in 35% participants in the broad scenario, 25% in the restrictive scenario, and 16% in the high‐risk scenario. In all, CAC=0 was associated with the lowest incident ASCVD rates at 5 and 10 years, and CAC burden was independently associated with ASCVD events adjusting for traditional risk factors. Conclusions CAC may be used to refine the allocation of PCSK9i, potentially leading to a more conservative use if CAC=0. The value of CAC testing is greater in scenarios that use low‐density lipoprotein cholesterol levels and/or traditional risk factors to define PCSK9i eligibility (CAC=0 present in 1 of 3–4 patients), whereas its prevalence is lower when allocation is informed by presence of noncoronary subclinical organ damage.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
| | - Reed Mszar
- Center for Outcomes Research Yale School of Medicine New Haven CT
| | - Ramzi Dudum
- Division of Cardiovascular Medicine Stanford University Stanford CA
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany.,Department of Epidemiology, School of Public Health Boston University Boston MA
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Sara Schramm
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen University Duisburg-Essen Essen Germany
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,CGH Medical Center Sterling IL.,University of Illinois College of Medicine Peoria IL
| | - Jamal S Rana
- Divisions of Cardiology and Research Kaiser Permanente Northern California Oakland CA
| | - Joao A C Lima
- Division of Cardiovascular Imaging Johns Hopkins Medical Institutions Baltimore MD
| | | | - Donald Lloyd-Jones
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD.,Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Baltimore MD
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins Medical Institutions Baltimore MD
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Mszar R, Webb GB, Kulkarni VT, Ahmad Z, Soffer D. Genetic Lipid Disorders Associated with Atherosclerotic Cardiovascular Disease: Molecular Basis to Clinical Diagnosis and Epidemiologic Burden. Med Clin North Am 2022; 106:325-348. [PMID: 35227434 DOI: 10.1016/j.mcna.2021.11.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genetic lipid disorders, ranging from common dyslipidemias such as familial hypercholesterolemia, lipoprotein (a), and familial combined hyperlipidemia to rare disorders including familial chylomicronemia syndrome and inherited hypoalphalipoproteinemias (ie, Tangier and fish eye diseases), affect millions of individuals in the United States and tens of millions around the world and are often undiagnosed in the general population. Clinicians should take into consideration the potential of inherited lipid disorders or syndromes when severe derangements in lipid parameters are observed. Patients' combined genotype and phenotype should be evaluated in conjunction with a host of environmental factors impacting their risk of atherosclerotic cardiovascular disease.
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Affiliation(s)
- Reed Mszar
- Yale Center for Outcomes Research and Evaluation, New Haven, CT, USA
| | - Gayley B Webb
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vivek T Kulkarni
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zahid Ahmad
- Division of Nutrition and Metabolic Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Soffer
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Sharma R, Baker A, Mszar R, Leasure AC, Khera R, de Havenon A, Lu Y, Jasne A, Forman R, Sheth KN, Krumholz HM, Sharma R. Abstract WP215: Population Attributable Risks For Potentially Modifiable Risk Factors Of Cerebrovascular And Cardiovascular-related Mortality In The National Health And Nutrition Examination Survey. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp215] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Stroke and heart disease are leading causes of mortality in the United States. We studied population attributable risks (PARs) for potentially modifiable stroke and cardiovascular-related mortality risk factors in the National Health and Nutrition Examination Survey (NHANES)-National Death Index (NDI) linked dataset.
Methods:
Adult NHANES participants surveyed from 1999-2014 with linked NDI data were included in this sample-level analysis. The primary outcome was death secondary to stroke (ischemic or hemorrhagic) or cardiovascular disease as recorded in NDI. Exposures were behavioral, environmental, clinical, and laboratory variables dichotomized at the sample median collected in NHANES. Missing data were imputed. PARs were calculated using adjusted hazard ratios from Cox proportional models.
Results:
We included 47,356 participants (median age 46 years [IQR 30-64]; 51.8% female; 261 stroke- and 1,112 cardiac-related deaths, 2.9%). Mean follow-up time was 97.2 months (SD 54.4 months). Among men < 65 years, characteristics with the top 3 PARs were elevated cholesterol (PAR 42%), elevated systolic blood pressure (PAR 30%), and low platelet count (PAR 23%) (Table 1). Among women < 65 years, not using food label nutritional fact panels (PAR 29%), prescription medication use (PAR 34%), and an elevated white blood cell count (PAR 27%) were the top 3 risk factors by PAR. Among men ≥ 65 years, not using food label nutritional fact panels (PAR 32%), elevated systolic blood pressure (PAR 22%), and cigarette smoking (PAR 20%) were the top 3 factors by PAR. Among women ≥ 65 years, not using food label nutritional fact panels (17%), elevated cholesterol (29%), and elevated creatinine (22%) were the top 3 risk factors by PAR.
Conclusions:
We provide age- and sex-specific adjusted PARs of potentially modifiable risk factors of stroke and cardiovascular-related mortality. These findings may inform targeted stroke and cardiovascular risk prevention strategies.
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Affiliation(s)
| | | | - Reed Mszar
- Yale Sch of Public Health, New Haven, CT
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12
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Sharma G, Grandhi GR, Acquah I, Mszar R, Mahajan S, Khan SU, Javed Z, Mehta LS, Gulati M, Cainzos-Achirica M, Blumenthal RS, Nasir K. Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States. J Am Heart Assoc 2022; 11:e022837. [PMID: 35014862 PMCID: PMC9238529 DOI: 10.1161/jaha.121.022837] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Suboptimal cardiovascular health (CVH) and social determinants of health (SDOH) have a significant impact on maternal morbidity and mortality. We aimed to evaluate the association of SDOH with suboptimal CVH among pregnant women in the United States. Methods and Results We examined cross‐sectional data of pregnant women aged 18 to 49 years from the National Health Interview Survey (2013–2017). We ascertained optimal and suboptimal CVH based on the presence of 0 to 1 and ≥2 risk factors (hypertension, diabetes, hyperlipidemia, current smoking, obesity, and insufficient physical activity), respectively. We calculated an aggregate SDOH score representing 38 variables from 6 domains (economic stability; neighborhood, physical environment, and social cohesion; community and social context; food; education; and healthcare system) and divided into quartiles. We used Poisson regression model to evaluate the association of SDOH with suboptimal CVH and risk factors. Our study included 1433 pregnant women (28.8±5.5 years, 13% non‐Hispanic Black). Overall, 38.4% (95% CI, 33.9–43.0) had suboptimal CVH versus 51.7% (95% CI, 47.0–56.3) among those in the fourth SDOH quartile. Risk ratios of suboptimal CVH, smoking, obesity, and insufficient physical activity were 2.05 (95% CI, 1.46–2.88), 8.37 (95% CI, 3.00–23.43), 1.54 (95% CI, 1.17–2.03), and 1.19 (95% CI, 1.01–1.42), respectively among those in the fourth SDOH quartile compared with the first quartile. Conclusions Over 50% of pregnant women with the highest SDOH burden had suboptimal CVH, highlighting the public health urgency for interventions in socially disadvantaged pregnant women with renewed strategies toward improving modifiable risk factors, especially smoking and insufficient physical activity.
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Affiliation(s)
- Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | | | - Isaac Acquah
- Division of Health Equity and Disparities Research Center for Outcomes Research The Houston Methodist Research Institute Houston TX
| | - Reed Mszar
- Center for Outcomes Research and EvaluationYale New Haven Health New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Shiwani Mahajan
- Center for Outcomes Research and EvaluationYale New Haven Health New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
| | - Zulqarnain Javed
- Division of Health Equity and Disparities Research Center for Outcomes Research The Houston Methodist Research Institute Houston TX
| | - Laxmi S Mehta
- Division of Cardiology Department of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Martha Gulati
- Division of Cardiology Department of Medicine University of Arizona Phoenix AZ
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Disparities Research Center for Outcomes Research The Houston Methodist Research Institute Houston TX.,Division of Cardiovascular Prevention and Wellness Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Khurram Nasir
- Division of Health Equity and Disparities Research Center for Outcomes Research The Houston Methodist Research Institute Houston TX.,Division of Cardiovascular Prevention and Wellness Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Cardiovascular Computational & Precision Health (C3-PH) Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX
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13
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Cainzos-Achirica M, Acquah I, Dardari Z, Mszar R, Greenland P, Blankstein R, Bittencourt M, Rajagopalan S, Al-Kindi SG, Polak JF, Blumenthal RS, Blaha MJ, Nasir K. Long-Term Prognostic Implications and Role of Further Testing in Adults Aged ≤55 Years With a Coronary Calcium Score of Zero (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2021; 161:26-35. [PMID: 34794615 PMCID: PMC8607758 DOI: 10.1016/j.amjcard.2021.08.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/23/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022]
Abstract
The long-term prognostic significance of a coronary artery calcium (CAC) score of 0 is poorly defined in younger adults. We evaluated this among participants aged 45 to 55 years from the Multi-Ethnic Study of Atherosclerosis, and assessed whether additional biomarkers can identify subgroups at increased absolute risk. We included 1,407 participants (61% women) without diabetes or severe hypercholesterolemia, with estimated 10-year risk <20% and CAC = 0. We evaluated all and hard cardiovascular disease (CVD) events, overall and among subjects with each of the following: high-sensitivity C-reactive protein levels ≥2 mg/L, homocysteine ≥10 µmol/L, high-sensitivity cardiac troponin T ≥95th percentile, lipoprotein (a) >50 mg/dl, triglycerides ≥175 mg/dl, apolipoprotein B ≥130 mg/dl, albuminuria, thoracic aortic calcium, aortic valve calcium (AVC), mitral annular calcium, ankle-brachial index <0.9, any carotid plaque, and maximum internal carotid artery intima-media thickness (ICA-IMT) ≥1.5 mm. Median follow-up was 16 years, and overall CVD event rates were low (4% at 15 years). For most exposures evaluated, rates of all CVD events were <6 per 1,000 person-years, except for ICA-IMT ≥1.5 mm (6.43) and AVC (13.8). The number needed to screen to detect ICA-IMT ≥1.5 mm was 8, and 84 for AVC. Among participants with borderline/intermediate risk or premature family history, hard CVD event rates were <7 per 1,000 for most exposures, except for ICA-IMT ≥1.5 mm (8.25), albuminuria (8.30), and AVC (13.47). Nonsmokers and those with ICA-IMT <1.5 mm had very low rates. In conclusion, our results demonstrate a favorable long-term prognosis of CAC = 0 among adults aged ≤55 years, particularly among nonsmokers. ICA-IMT testing could be considered for further risk assessment in adults ≤55 years with CAC = 0 and uncertain management.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist, Houston, Texas.
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reed Mszar
- Center for Outcomes Research, Yale University, New Haven, Connecticut Yale University, New Haven, Connecticut
| | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marcio Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph F Polak
- Tufts University School of Medicine, Boston, Massachusetts; Department of Radiology, Lemuel Shattuck Hospital, Boston, Massachusetts
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist, Houston, Texas
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14
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Grandhi GR, Mszar R, Cainzos-Achirica M, Rajan T, Latif MA, Bittencourt MS, Shaw LJ, Batlle JC, Blankstein R, Blaha MJ, Cury RC, Nasir K. Coronary Calcium to Rule Out Obstructive Coronary Artery Disease in Patients With Acute Chest Pain. JACC Cardiovasc Imaging 2021; 15:271-280. [PMID: 34656462 DOI: 10.1016/j.jcmg.2021.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 02/08/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to evaluate the ability of coronary artery calcium (CAC) as an initial diagnostic tool to rule out obstructive coronary artery disease (CAD) in a very large registry of patients presenting to the emergency department (ED) with acute chest pain (CP) who were at low to intermediate risk for acute coronary syndrome (ACS). BACKGROUND It is not yet well established whether CAC can be used to rule out obstructive CAD in the ED setting. METHODS We included patients from the Baptist Health South Florida Chest Pain Registry presenting to the ED with CP at low to intermediate risk for ACS (Thrombolysis In Myocardial Infarction risk score ≤2, normal/nondiagnostic electrocardiography, and troponin levels) who underwent CAC and coronary computed tomography angiography (CCTA) procedures for evaluation of ACS. To assess the diagnostic accuracy of CAC testing to diagnose obstructive CAD and identify the need for coronary revascularization during hospitalization, we estimated sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). RESULTS Our study included 5,192 patients (mean age: 53.5 ± 10.8 years; 46% male; 62% Hispanic). Overall, 2,902 patients (56%) had CAC = 0, of which 135 (4.6%) had CAD (114 [3.9%] nonobstructive and 21 [0.7%] obstructive). Among those with CAC >0, 23% had obstructive CAD. Sensitivity, specificity, PPV, and NPV of CAC testing to diagnose obstructive CAD were 96.2%, 62.4%, 22.4%, and 99.3%, respectively. The NPV for identifying those who needed revascularization was 99.6%. Among patients with CAC = 0, 11 patients (0.4%) underwent revascularization, and the number needed to test with CCTA to detect 1 patient who required revascularization was 264. CONCLUSIONS In a large population presenting to ED with CP at low to intermediate risk, CAC = 0 was common. CAC = 0 ruled out obstructive CAD and revascularization in more than 99% of the patients, and <5% with CAC = 0 had any CAD. Integrating CAC testing very early in CP evaluation may be effective in appropriate triage of patients by identifying individuals who can safely defer additional testing and more invasive procedures.
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Affiliation(s)
- Gowtham R Grandhi
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, Florida, USA; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Disparities Research, Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas, USA; Department of Cardiovascular Medicine, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Tanuja Rajan
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Muhammad A Latif
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leslee J Shaw
- Weill Cornell Medical College, New York, New York, USA
| | - Juan C Batlle
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, Florida, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Ron Blankstein
- Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, Florida, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Khurram Nasir
- Division of Health Equity and Disparities Research, Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas, USA; Department of Cardiovascular Medicine, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiovascular Medicine, Center for Cardiovascular Computational and Precision Health (C3-PH), Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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15
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Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, Virani S, Cainzos-Achirica M, Nasir K. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol 2021; 7:100219. [PMID: 34611645 PMCID: PMC8387290 DOI: 10.1016/j.ajpc.2021.100219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. METHODS : Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. RESULTS : Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. CONCLUSION : We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Murrium I. Sadaf
- Yale New Haven Medical Center (Waterbury) Internal Medicine Residency Program, Waterbury, CT, United States
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Gowtham R. Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Hassan Zawahir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Reed Mszar
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, CT, United States
| | - Bashir Hanif
- Dean, Faculty of Cardiology, College of Physicians and Surgeons Pakistan (CPSP), Pakistan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, United States
| | - Salim Virani
- Section of Cardiovascular Research, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
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16
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Mahajan S, Grandhi GR, Valero-Elizondo J, Mszar R, Khera R, Acquah I, Yahya T, Virani SS, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Scope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States. J Am Heart Assoc 2021; 10:e020028. [PMID: 34387089 PMCID: PMC8475063 DOI: 10.1161/jaha.120.020028] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) results in high out‐of‐pocket healthcare expenditures predisposing to food insecurity. However, the burden and determinants of food insecurity in this population are unknown. Methods and Results Using 2013 to 2018 National Health Interview Survey data, we evaluated the prevalence and sociodemographic determinants of food insecurity among adults with ASCVD in the United States. ASCVD was defined as self‐reported diagnosis of coronary heart disease or stroke. Food security was measured using the 10‐item US Adult Food Security Survey Module. Of the 190 113 study participants aged 18 years or older, 18 442 (adjusted prevalence 8.2%) had ASCVD, representing ≈20 million US adults annually. Among adults with ASCVD, 2968 or 14.6% (weighted ≈2.9 million US adults annually) reported food insecurity compared with 9.1% among those without ASCVD (P<0.001). Individuals with ASCVD who were younger (odds ratio [OR], 4.0 [95% CI, 2.8–5.8]), women (OR, 1.2 [1.0–1.3]), non‐Hispanic Black (OR, 2.3 [1.9–2.8]), or Hispanic (OR, 1.6 [1.2–2.0]), had private (OR, 1.8 [1.4–2.3]) or no insurance (OR, 2.3 [1.7–3.1]), were divorced/widowed/separated (OR, 1.2 [1.0–1.4]), and had low family income (OR, 4.7 [4.0–5.6]) were more likely to be food insecure. Among those with ASCVD and 6 of these high‐risk characteristics, 53.7% reported food insecurity and they had 36‐times (OR, 36.2 [22.6–57.9]) higher odds of being food insecure compared with those with ≤1 high‐risk characteristic. Conclusion About 1 in 7 US adults with ASCVD experience food insecurity, with more than 1 in 2 adults reporting food insecurity among the most vulnerable sociodemographic subgroups. There is an urgent need to address the barriers related to food security in this population.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | | | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Reed Mszar
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Rohan Khera
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Isaac Acquah
- Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center & Section of Cardiology Baylor College of Medicine Houston TX
| | - Ron Blankstein
- Cardiovascular Imaging Program Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
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17
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Bhugra P, Grandhi GR, Mszar R, Satish P, Singh R, Blaha M, Blankstein R, Virani SS, Cainzos-Achirica M, Nasir K. Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement. J Am Heart Assoc 2021; 10:e019671. [PMID: 34315229 PMCID: PMC8475658 DOI: 10.1161/jaha.120.019671] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.
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Affiliation(s)
| | | | - Reed Mszar
- Center for Outcomes Research and EvaluationYale New Haven Health New Haven CT
| | - Priyanka Satish
- Department of CardiologyHouston Methodist Hospital Houston TX
| | - Rahul Singh
- Department of Internal Medicine Houston Methodist Hospital Houston TX
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center Houston TX.,Baylor College of Medicine Houston TX
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Department of CardiologyHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Yale University New Haven CT
| | - Khurram Nasir
- Division Health Equity & Disparities Research Center for Outcomes Research Houston Methodist Hospital Houston TX.,Division of Cardiovascular Prevention and Wellness Department of Cardiovascular MedicineHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Cardiovascular Computational & Precision Health (C3-PH) Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Division of Cardiology Yale University New Haven CT
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18
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Nguemeni Tiako MJ, Mszar R, Brooks C, Bin Mahmood SU, Mori M, Vallabhajosyula P, Geirsson A, Weimer MB. Cardiac surgeons' practices and attitudes toward addiction care for patients with substance use disorders. Subst Abus 2021; 43:206-211. [PMID: 34038333 DOI: 10.1080/08897077.2021.1917475] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Rates of injection-drug use associated infective endocarditis (IDU-IE) are rising, and most patients with IDU-IE do not receive addiction care during hospitalization. We sought to characterize cardiac surgeons' practices and attitudes toward patients with IDU-IE due to their integral role treating them. METHODS This is a survey of 201 cardiac surgeons in the U.S who were asked about the addiction care they engage for patients with IDU-IE along with questions pertaining to stigma against people who use drugs (PWUD). Descriptive statistics and multivariable logistic regression were used to identify patterns in surgeons' practices and determine associations between attitudes toward substance use disorder (SUD) and beliefs about medications for opioid use disorder (MOUD). RESULTS A minority of surgeons have access to specialty addiction services (35%) in their hospital, but when available 93% consult them for patients with IDU-IE. A quarter of surgeons reported thinking that SUD is a choice and do not believe MOUD have a role in reducing IDU-IE recurrence. Conversely, 69% of surgeons agreed with the disease model of addiction and were four times more likely to believe that MOUD has a role in reducing IDU-IE recurrence (aOR 4.09, 95% CI 1.8-9.27, p = 0.001). CONCLUSION Access to addiction specialists is limited in most hospital settings, but when available, most surgeons report consulting them and supporting MOUD. However, a significant proportion of surgeons hold non-evidence-based attitudes toward SUD and PWUD. This suggests that lack of education and stigma may affect the care of patients with IDU-IE, highlighting the need for education about, and destigmatization of addiction within health systems.
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Affiliation(s)
| | - Reed Mszar
- School of Public Health, Yale University, New Haven, CT, USA
| | - Cornell Brooks
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Syed Usman Bin Mahmood
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Prashanth Vallabhajosyula
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Melissa B Weimer
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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19
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Nasir K, Mszar R, Cainzos-Achirica M, Grandhi G, Karlezi RA, Bittencourt M, Bruckert E, Díaz-Díaz JL, Gallo A, Hovingh GK, Miname M, Muñiz-Grijalvo O, Pang J, de Isla LP, Sijbrands E, Tromp T, Watts G, Mata P, Santos R. PRESENCE AND BURDEN OF CORONARY ATHEROSCLEROSIS IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02769-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Grandhi GR, Mozafarian M, Mszar R, Acquah I, Valero-Elizondo J, Cainzos-Achirica M, Omer SB, Ibrahim HN, Nasir K. Influenza Vaccination Among Adults With CKD in the United States: Regional, Demographic, and Socioeconomic Differences. Kidney Med 2021; 3:454-456. [PMID: 34136792 PMCID: PMC8178475 DOI: 10.1016/j.xkme.2020.12.012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | | | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT
| | - Isaac Acquah
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, CT.,Yale School of Nursing, New Haven, CT.,Department of Internal Medicine (Infectious Diseases), Yale School of Public Health, New Haven, CT.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX.,Division of Cardiology, Yale University, New Haven, CT
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21
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Mszar R, Santos RD, Nasir K. Addressing Gaps in Racial/Ethnic Representation in Familial Hypercholesterolemia Registries: Implications and Recommendations for Equitable Access to Research and Care. Circ Cardiovasc Qual Outcomes 2021; 14:e007306. [PMID: 33508946 DOI: 10.1161/circoutcomes.120.007306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M.)
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital Brazil (R.D.S.)
- Hospital Israelita Albert Einstein, São Paulo, Brazil (R.D.S.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N.)
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.N.)
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22
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Mszar R, Gopal DJ, Chowdary R, Smith CL, Dolin CD, Irwin ML, Soffer D, Nemiroff R, Lewey J. Racial/Ethnic Disparities in Screening for and Awareness of High Cholesterol Among Pregnant Women Receiving Prenatal Care. J Am Heart Assoc 2021; 10:e017415. [PMID: 33345544 PMCID: PMC7955491 DOI: 10.1161/jaha.120.017415] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/20/2020] [Indexed: 01/15/2023]
Abstract
Background Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality among women, with younger women being disproportionately affected by traditional cardiovascular risk factors such as dyslipidemia. Despite recommendations for lipid screening in early adulthood and the risks associated with maternal dyslipidemia during pregnancy, many younger women lack access to and utilization of early screening. Accordingly, our objective was to assess the prevalence of and disparities in lipid screening and awareness of high cholesterol as an atherosclerotic cardiovascular disease risk factor among pregnant women receiving prenatal care. Methods and Results We invited 234 pregnant women receiving prenatal care at 1 of 3 clinics affiliated with the University of Pennsylvania Health System to complete our survey. A total of 200 pregnant women (86% response rate) completed the survey. Overall, 59% of pregnant women (mean age 32.2 [±5.7] years) self-reported a previous lipid screening and 79% of women were aware of high cholesterol as an atherosclerotic cardiovascular disease risk factor. Stratified by racial/ethnic subgroups, non-Hispanic Black women were less likely to report a prior screening (43% versus 67%, P=0.022) and had lower levels of awareness (66% versus 92%, P<0.001) compared with non-Hispanic White women. Non-Hispanic Black women were more likely to see an obstetrician/gynecologist for their usual source of non-pregnancy care compared with non-Hispanic White women (18% versus 5%, P=0.043). Those seeing an obstetrician/gynecologist for usual care were less likely to report a prior lipid screening compared with those seeing a primary care physician (29% versus 63%, P=0.007). Conclusions Significant racial/ethnic disparities persist in lipid screening and risk factor awareness among pregnant women. Prenatal care may represent an opportunity to enhance access to and uptake of screening among younger women and reduce variations in accessing preventive care services.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCT
| | - Dipika J. Gopal
- Division of CardiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Rupa Chowdary
- Department of MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Cara Lea Smith
- Division of CardiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Cara D. Dolin
- Department of Obstetrics and GynecologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Melinda L. Irwin
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCT
| | - Daniel Soffer
- Division of CardiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Richard Nemiroff
- Department of Obstetrics and GynecologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Jennifer Lewey
- Division of CardiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
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23
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Mszar R, Buscher S, McCann D, Taylor HL. Self-Efficacy, Perceived Barriers to Care, and Health-Promoting Behaviors Among Franco-Americans Across Cardiovascular Risk Factors: A Cross-Sectional Study. Am J Health Promot 2020; 35:703-707. [PMID: 33375809 DOI: 10.1177/0890117120982412] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. DESIGN Cross-sectional survey based on components of the Health Belief Model. SETTING Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States. SAMPLE Franco-Americans and French Canadians (n = 170). MEASURES Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). RESULTS In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). CONCLUSION Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Sara Buscher
- Division of General Pediatrics, 1862Boston Children's Hospital, Boston, MA, USA
| | - Dervilla McCann
- Department of Cardiology, Central Maine Medical Center, Lewiston, ME, USA
| | - Heidi L Taylor
- Department of Sociology, 4521Bates College, Lewiston, ME, USA
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24
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Nguemeni Tiako MJ, Mszar R, Brooks C, Mahmood SUB, Mori M, Geirsson A, Weimer MB. Cardiac Surgeons' Treatment Approaches for Infective Endocarditis Based on Patients' Substance Use History. Semin Thorac Cardiovasc Surg 2020; 33:703-709. [PMID: 33279690 DOI: 10.1053/j.semtcvs.2020.11.031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022]
Abstract
U.S. cardiac surgeons encounter complex decision-making when treating patients with injection drug use-associated infective endocarditis (IDU-IE). We evaluated surgeons' treatment approaches for IDU-IE compared to non-IDU-IE. This is an anonymous survey of U.S. cardiac surgeons who answered hypothetical infective endocarditis (IE) clinical scenarios that varied based on patient substance use history, addiction treatment, and history of IE. Treatment approaches were classified as operative vs nonoperative. Responses were descriptively analyzed. The survey response rate was 8.7% (n = 208). Survey respondents were mostly male (85.6%) and non-Hispanic white (67.8%), but were from all regions of the United States. Surgeons reported they would operate at similar proportions for patients with native valve non-IDU-IE (63%) and IDU-IE engaged in methadone treatment (64.5%). Most surgeons reported they would operate on patients with recurrent non-IDU-IE (93.1%) compared to only 26.4% for patients with recurrent IDU-IE (P < 0.001). Most surgeons reported they would place no limits on the number of operations for patients with recurrent non-IDU-IE (73.1%), whereas 83.5% of surgeons would limit the number of surgeries for patients with recurrent IDU-IE (P < 0.001). Most respondents reported having declined to operate on patients with IDU-IE (63.5%). Cardiac surgeons are less likely to report favoring operative management for primary and recurrent infection in patients with IDU-IE, though patient engagement in methadone treatment increased the likelihood of them taking an operative approach. There is opportunity to standardize the care, including addiction treatment, of patients with IDU-IE to optimize positive short and long-term outcomes.
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Affiliation(s)
| | - Reed Mszar
- Yale University School of Public Health, New Haven, CT
| | - Cornell Brooks
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Syed Usman Bin Mahmood
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Melissa B Weimer
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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25
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Mszar R, Mahajan S, Valero-Elizondo J, Grandhi GR, Caraballo C, Gopal DJ, Nemiroff RL, Soffer DE, Cainzos-Achirica M, Sharma G, Nasir K. Disparities in cholesterol screening among a nationally representative sample of pregnant women in the United States. Eur J Prev Cardiol 2020; 29:e11-e13. [PMID: 33624106 DOI: 10.1093/eurjpc/zwaa100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 07/06/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, USA
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Dipika J Gopal
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Richard L Nemiroff
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel E Soffer
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
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26
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Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020; 51:3552-3561. [PMID: 33100188 DOI: 10.1161/strokeaha.120.031137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States. METHODS Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults (<45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache. RESULTS Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17-3.28]), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31-3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76-4.35]), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43-5.62]). CONCLUSIONS Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Shiwani Mahajan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Javier Valero-Elizondo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Tamer Yahya
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Richa Sharma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Gowtham R Grandhi
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Rohan Khera
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Salim S Virani
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Judith Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Safi U Khan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Miguel Cainzos-Achirica
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Farhaan S Vahidy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Harlan M Krumholz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Khurram Nasir
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
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Bhugra P, Mszar R, Valero-Elizondo J, Grandhi GR, Virani SS, Cainzos-Achirica M, Vahidy FS, Omer S, Nasir K. Prevalence of and Sociodemographic Disparities in Influenza Vaccination Among Adults With Diabetes in the United States. J Endocr Soc 2020; 4:bvaa139. [PMID: 33123656 PMCID: PMC7575128 DOI: 10.1210/jendso/bvaa139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022] Open
Abstract
National estimates describing the overall prevalence of and disparities in influenza vaccination among patients with diabetes mellitus (DM) in United States are not well described. Therefore, we analyzed the prevalence of influenza vaccination among adults with DM, overall and by sociodemographic characteristics, using the Medical Expenditure Panel Survey database from 2008 to 2016. Associations between sociodemographic factors and lack of vaccination were examined using adjusted logistic regression. Among adults with DM, 36% lacked influenza vaccination. Independent predictors of lacking influenza vaccination included age 18 to 39 years (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.14-3.00), Black race/ethnicity (OR 1.29; 95% CI, 1.14-1.46), uninsured status (OR 1.88; 95% CI, 1.59-2.21), and no usual source of care (OR 1.61; 95% CI, 1.39-1.85). Nearly 64% individuals with ≥ 4 higher-risk sociodemographic characteristics lacked influenza vaccination (OR 3.50; 95% CI 2.79-4.39). One-third of adults with DM in the United States lack influenza vaccination, with younger age, Black race, and lower socioeconomic status serving as strong predictors. These findings highlight the continued need for focused public health interventions to increase vaccine coverage and utilization among disadvantaged communities.
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Affiliation(s)
- Priyanka Bhugra
- Hospital Medicine, Houston Methodist Hospital, Houston, Texas
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas
| | - Saad Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut.,Department of Internal Medicine (Infectious Disease), Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut.,Yale School of Nursing, Yale University, Orange, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Grandhi GR, Mszar R, Vahidy F, Valero-Elizondo J, Blankstein R, Blaha MJ, Virani SS, Andrieni JD, Omer SB, Nasir K. Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiol 2020; 6:87-91. [PMID: 32902562 DOI: 10.1001/jamacardio.2020.3978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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
Importance Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death and disability in the US and worldwide. Influenza vaccination has shown to decrease overall morbidity, mortality, severity of infection, and hospital readmissions among these individuals. However, national estimates of influenza vaccination among individuals with ASCVD in the US are not well studied. Objective To evaluate the prevalence of and sociodemographic disparities in influenza vaccination among a nationally representative sample of individuals with ASCVD. Design, Setting, and Participants Pooled Medical Expenditure Panel Survey data from 2008 to 2016 were used and included adults 40 years or older with ASCVD. Participants' ASCVD status was ascertained via self-report and/or International Classification of Diseases, Ninth Revision diagnosis of coronary heart disease, peripheral artery disease, and/or cerebrovascular disease. Analysis began April 2020. Main Outcomes and Measures Prevalence and characteristics of adults with ASCVD who lacked influenza vaccination during the past year. Covariates including age, sex, race/ethnicity, family income, insurance status, education level, and usual source of care were assessed. Results Of 131 881 adults, 19 793 (15.7%) had ASCVD, corresponding to 22.8 million US adults annually. A total of 7028 adults with ASCVD (32.7%), representing 7.4 million adults, lacked influenza vaccination. The highest odds of lacking vaccination were observed among individuals aged 40 to 64 years (odds ratio [OR], 2.32; 95% CI, 2.06-2.62), without a usual source of care (OR, 2.00; 95% CI, 1.71-2.33), without insurance (OR, 2.05; 95% CI, 1.63-2.58), with a lower education level (OR, 1. 25; 95% CI, 1.12-1.40), with a lower income level (OR, 1.14; 95% CI, 1.01-1.27), and of non-Hispanic Black race/ethnicity (OR, 1.24, 95% CI, 1.10-1.41). A stepwise increase was found in the prevalence and odds of lacking influenza vaccination among individuals with increase in high-risk characteristics. Overall, 1171 individuals (59.7%; 95% CI, 55.8%-63.5%) with 4 or more high-risk characteristics and ASCVD (representing 732 524 US adults annually) reported lack of influenza vaccination (OR, 6.06; 95% CI, 4.88-7.53). Conclusion and Relevance Despite current recommendations, a large proportion of US adults with established ASCVD lack influenza vaccination, with several sociodemographic subgroups having greater risk. Focused public health initiatives are needed to increase access to influenza vaccinations for high-risk and underserved populations.
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Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Farhaan Vahidy
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Julia D Andrieni
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, Connecticut.,Yale School of Nursing, New Haven, Connecticut.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Division of Cardiology, Yale University, New Haven, Connecticut
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Yahya T, Jilani MH, Khan SU, Mszar R, Hassan SZ, Blaha MJ, Blankstein R, Virani SS, Johansen MC, Vahidy F, Cainzos-Achirica M, Nasir K. Stroke in young adults: Current trends, opportunities for prevention and pathways forward. Am J Prev Cardiol 2020; 3:100085. [PMID: 34327465 PMCID: PMC8315351 DOI: 10.1016/j.ajpc.2020.100085] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward.
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Affiliation(s)
- Tamer Yahya
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Safi U. Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Syed Zawahir Hassan
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Michael J. Blaha
- Ciccarone Center of the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Ron Blankstein
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Salim S. Virani
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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Jafar Z, Valero-Elizondo J, Saeed GJ, Acquah I, Yahya T, Mahajan S, Mszar R, Khan SU, Caínzos-Achirica M, Nasir K. Association of cardiovascular risk profile with healthcare expenditure and resource utilization in chronic obstructive pulmonary disease, with and without atherosclerotic cardiovascular disease. Am J Prev Cardiol 2020; 3:100084. [PMID: 34327464 PMCID: PMC8315593 DOI: 10.1016/j.ajpc.2020.100084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/13/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Atherosclerotic cardiovascular disease (ASCVD) and chronic obstructive pulmonary disease (COPD) are among the leading causes of morbidity, mortality, and economic burden in the United States (US). While previous reports have shown that an optimal cardiovascular risk factor (CRF) profile is associated with improved outcomes among COPD patients, the impact of ASCVD and CRF on healthcare costs and resource utilization is not well described. Methods The Medical Expenditure Panel Survey (MEPS) database was used from 2011 to 2016 to study healthcare expenditure for COPD patients with and without ASCVD and across CRF profiles in a nationally representative population of adults in the United States. Results The study population consisted of 14,807 adults with COPD, representing 28 million cases annually. Presence of ASCVD was associated with higher reported expenditure across the spectrum of CRF profiles among those with COPD. On average, after adjusting for confounders, presence of ASCVD represented a mean difference per capita of $5438 (95% CI $4121 - $6754; p < 0.001). Mean per capita expenditures were significantly higher comparing poor vs optimal CRF profiles, with marginal expenditures of $8552 and $6531 among those with and without ASCVD, respectively. When comparing individuals with ASCVD and poor CRF profile versus individuals without ASCVD and optimal CRF profile, those in the latter group used 13% fewer prescription medications and required 24% fewer hospitalizations. Furthermore, an optimal CRF profile was associated with lower odds of most sources of healthcare utilization regardless of ASCVD status. Conclusion An absence of ASCVD and a favorable CRF profile was associated with lower healthcare expenditure and resource utilization among patients with COPD. These results provide robust estimates for potential healthcare savings as preemptive strategies continue to become integrated into new healthcare delivery models, for increased awareness and the need for improvement of CRF profiles among high-risk patients.
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Affiliation(s)
- Zain Jafar
- Horace Greeley High School, Chappaqua, NY, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Houston Methodist Research Institute, Houston, TX, USA
| | - Gul Jana Saeed
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Isaac Acquah
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Houston Methodist Research Institute, Houston, TX, USA
| | - Tamer Yahya
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Miguel Caínzos-Achirica
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Houston Methodist Research Institute, Houston, TX, USA.,Center for Outcomes Research, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Grandhi GR, Valero-Elizondo J, Mszar R, Brandt EJ, Annapureddy A, Khera R, Saxena A, Virani SS, Blankstein R, Desai NR, Blaha MJ, Cheema FH, Vahidy FS, Nasir K. Association of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States. Am J Prev Cardiol 2020; 2:100034. [PMID: 34327457 PMCID: PMC8315456 DOI: 10.1016/j.ajpc.2020.100034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background While optimal cardiovascular risk factor (CRF) profile is associated with lower mortality, morbidity, and healthcare expenditures among individuals with atherosclerotic cardiovascular disease (ASCVD), less is known regarding its impact on financial hardship from medical bills. Therefore, we assessed whether an optimal CRF profile is associated with a lower burden of financial hardship from medical bills and a reduction in cost-related barriers to health. Methods We used a nationally representative sample of adults between 18 and 64 years from the National Health Interview Survey between 2013 and 2017. We assessed ASCVD status and the number of risk factors to categorize the study population into 4 mutually exclusive categories: ASCVD (irrespective of CRF profile) and non-ASCVD with poor, average, and optimal CRF profile. Adjusted logistic regression model was used to determine the association of ASCVD/CRF profile with financial hardship from medical bills and cost-related barriers to health (cost-related medication non-adherence (CRN), foregone/delayed care, and high financial distress). Results We included 119,388 non-elderly adults, representing 189 million individuals annually across the United States. Non-ASCVD/optimal CRF profile individuals had a lower prevalence of financial hardship and an inability paying medical bills when compared with individuals with ASCVD (24% vs 45% and 6% vs 19%, respectively). Among individuals without ASCVD and an optimal CRF profile, the prevalence of each cost-related barrier to health was <50% compared with individuals with ASCVD. Poor/low income and uninsured individuals within non-ASCVD/average CRF profile strata had a lower prevalence of financial hardship and an inability paying medical bills when compared with middle/high income and insured individuals with ASCVD. Non-ASCVD individuals with optimal CRF profile had the lowest odds of all barriers to health. Conclusion Optimal CRF profile is associated with a lower prevalence of financial hardship from medical bills and cost-related barriers to health despite lower income and lack of insurance.
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Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Eric J Brandt
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Amarnath Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Ron Blankstein
- Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, USA.,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Faisal H Cheema
- University of Houston College of Medicine, Houston, TX, USA.,HCA Research Institute, Nashville, TN, USA
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.,Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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Mszar R, Grandhi GR, Valero-Elizondo J, Caraballo C, Khera R, Desai N, Virani SS, Blankstein R, Blaha MJ, Nasir K. Cumulative Burden of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non-Elderly Adults in the United States. J Am Heart Assoc 2020; 9:e015523. [PMID: 32394783 PMCID: PMC7660844 DOI: 10.1161/jaha.119.015523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) has a strong association with diabetes mellitus (DM), accounting for approximately two thirds of deaths in this patient population. Many individuals with ASCVD and DM are vulnerable to financial hardship associated with treatment-related expenses. Therefore, we examined the burden of financial hardship from medical bills across the spectrum of ASCVD status with and without DM. Methods and Results Using data from the National Health Interview Survey from 2013 to 2017, we used logistic regression analysis to examine the association of ASCVD and DM status with financial hardship and an inability to pay medical bills from a representative sample of non-elderly adults in the United States. Our study population consisted of 121 672 individuals. Approximately 3.1% of the weighted population had ASCVD, 5.6% had DM, and 1.3% had both ASCVD and DM. Nearly 50% of individuals with ASCVD and DM reported financial hardship from medical bills (23% being unable to pay medical bills at all), whereas ≈28% of those with neither ASCVD nor DM reported financial hardship from medical bills (8% being unable to pay medical bills at all). Individuals with concurrent ASCVD and DM had the highest relative odds of expressing an inability to pay at all when compared with those with neither condition (odds ratio, 2.69; 95% CI, 2.21-3.28). Conclusions Individuals with concurrent ASCVD and DM are at a disproportionately high risk of being unable to pay their medical bills. The findings provide strong evidence for developing more effective public health policies that protect vulnerable populations from financial hardship.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology Yale School of Public Health New Haven CT.,Center for Outcomes Research and Evaluation Yale New Haven Health New Haven CT
| | | | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - César Caraballo
- Center for Outcomes Research and Evaluation Yale New Haven Health New Haven CT
| | - Rohan Khera
- University of Texas Southwestern Medical Center Dallas TX
| | - Nihar Desai
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston TX
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Nguemeni Tiako MJ, Mori M, Bin Mahmood SU, Mszar R, Brooks C, Bonde P, Tellides G, Weimer M, Geirsson A. Abstract 215: Cardiac Surgeons' Treatment Preferences for Infective Endocarditis Based on Patients' Drug Use Status. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.215] [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: 11/16/2022]
Abstract
Purpose:
With the current opioid epidemic, U.S. cardiac surgeons are increasingly facing complex medical decision-making for patients with injection drug use-associated infective endocarditis (IDU-IE). Guidelines for IE recommend that normal indications for surgery be applied to IDU-IE. We evaluated cardiac surgeons’ treatment preferences for IDU and non-IDU-IE.
Methods:
We sent an anonymous survey to 2398 cardiac surgeons in the U.S., of whom 254 (10.6%) responded. Of those respondents, 208 completed the questions of interest. Treatment options were presented as hypothetical clinical scenarios of IE with categorical responses. Scenarios varied based on patient drug use status, patient adherence to addiction treatment, and nature of the valve (recurrent vs. native). Treatment preferences were classified as operative vs non-operative. McNemar and Wilcoxon signed-rank tests were used to determine differences in response to scenarios. Statistical significance was defined as P< 0.05. Respondents’ demographic data were collected.
Results:
In patients with native valve non-IDU-IE, 131 (63%) would operate, and 77 (37%) would not. For patients with native valve IDU-IE and adherent to addiction treatment, 76 (36.5%) would not operate, while 132 (64.5%) would. In cases of recurrent IE, 175 (93.1%) surgeons would operate on non-IDU-IE vs 55 (26.4%) on IDU-IE. The difference in treatment preference for recurrent IDU-IE vs recurrent non-IDU-IE was statistically significant by McNemar’s test (OR 0.16, CI [0.08, 0.27] P <0.001). Nearly three quarters (152, 73.1%) stated no limits on operations for non-IDU-IE in case of recurrence, vs 34 (16.5%) for IDU-IE. Others limited to 1 (83, 40.3%), 2 (79, 38.4%),or 3 (10, 4.9%) operations for IDU-IE, vs 1 (13, 6.3%), 2 (30, 14.5%) or 3 (13, 6.3%) for non-IDU-IE. Wilcoxon signed-rank test showed a statistically significant difference in the limit number of operations for recurrent non-IDU-IE vs recurrent IDU-IE (z = -4.9, P <0.001). Most respondents report having denied operating for IDU-IE (132, 63.5%), unlike 49 (23.6%) who have not, while 24 (11.5%) have delayed operating. Most respondents who have denied operating did not refer patients to a different surgeon or hospital. Active drug use and recurrent endocarditis were the leading reasons cited for denying operating for IDU-IE.
Conclusion:
Cardiac surgeons have different treatment preference for IE based on patients' underlying substance use disorder diagnosis. Surgeons are less likely to offer operation for primary and recurrent valve infection to patients with IDU-IE, and patient adherence to addiction treatment may be protective against denial of operation. This indicates a need for increased education of cardiac surgeons on addiction, and a multidisciplinary approach to care in order to address the disparity in treatment and management between IDU-IE and non-IDU-IE.
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Affiliation(s)
| | | | | | - Reed Mszar
- Yale Sch of Public Health, New Haven, CT
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Mszar R, Buscher S, Taylor HL, Rice-DeFosse MT, McCann D. Familial Hypercholesterolemia and the Founder Effect Among Franco-Americans: A Brief History and Call to Action. CJC Open 2020; 2:161-167. [PMID: 32462130 PMCID: PMC7242505 DOI: 10.1016/j.cjco.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 01/01/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an inherited disorder characterized by chronically elevated low-density lipoprotein cholesterol levels and an increased risk of premature atherosclerotic cardiovascular disease. FH has been shown to disproportionately affect French Canadians and other ethnic populations due to the presence of a founder effect characterized by reduced genetic diversity resulting from relatively few individuals with FH-causing genetic mutations establishing self-contained populations. Beginning in the mid-1800s, approximately 1 million French Canadians immigrated to the Northeastern United States and largely remained in these small, tight-knit communities. Despite extensive genetic- and population-based research involving the French-Canadian founder population, primarily in the Province of Quebec, little is known regarding Franco-Americans in the United States. Concurrent with addressing the underdiagnosis rate of FH in the general population, we propose the following steps to leverage this founder effect and meet the cardiovascular needs of Franco-Americans: (1) increase cascade screening in regions of the United States with a high proportion of individuals of French-Canadian descent; (2) promote registry-based, epidemiological research to elucidate accurate prevalence estimates as well as diagnostic and treatment gaps in Franco-Americans; and (3) validate contemporary risk stratification strategies such as the Montreal-FH-SCORE to enable optimal lipid management and prevention of premature atherosclerotic cardiovascular disease among French-Canadian descendants.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sara Buscher
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Heidi L. Taylor
- Department of Sociology, Bates College, Lewiston, Maine, USA
| | - Mary T. Rice-DeFosse
- Department of French and Francophone Studies, Bates College, Lewiston, Maine, USA
| | - Dervilla McCann
- Department of Cardiology, Central Maine Medical Center, Lewiston, Maine, USA
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Caraballo C, Valero-Elizondo J, Khera R, Mahajan S, Grandhi GR, Virani SS, Mszar R, Krumholz HM, Nasir K. Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States. Circ Cardiovasc Qual Outcomes 2020; 13:e006139. [DOI: 10.1161/circoutcomes.119.006139] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 12/20/2022]
Abstract
Background:
The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus.
Methods and Results:
We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18–1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05–1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16–1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30–1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20–1.40]).
Conclusions:
Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.)
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (J.V.-E., K.N.)
- Center for Outcomes Research, Houston Methodist, TX (J.V.-E., K.N.)
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K.)
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.)
| | - Gowtham R. Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD (G.R.G.)
| | - Salim S. Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.)
- Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.)
- Department of Chronic Disease Epidemiology (R.M.), Yale School of Public Health, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.)
- Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (J.V.-E., K.N.)
- Center for Outcomes Research, Houston Methodist, TX (J.V.-E., K.N.)
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Mszar R, Grandhi GR, Valero-Elizondo J, Virani SS, Blankstein R, Blaha M, Mata P, Miname MH, Al Rasadi K, Krumholz HM, Santos RD, Nasir K. Absence of Coronary Artery Calcification in Middle-Aged Familial Hypercholesterolemia Patients Without Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging 2019; 13:1090-1092. [PMID: 31843585 DOI: 10.1016/j.jcmg.2019.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 01/01/2023]
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Mszar R, Buscher S, Taylor H, McCann D. Perceived Barriers to Lipid Management for Suspected Familial Hypercholesterolemia Franco-American Founder Populations*. J Clin Lipidol 2019. [DOI: 10.1016/j.jacl.2019.04.059] [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: 10/26/2022]
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Mszar R, Grandhi GR, Valero-Elizondo J, Khera R, Desai N, Virani S, Blankstein R, Blaha M, Nasir K. Abstract 157: Assessment of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non-Elderly Adults in the United States. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.157] [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: 11/16/2022]
Abstract
Background:
Diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) both increase the risk for experiencing an adverse cardiac event and affected individuals often have large medical expenditures. While prior research has evaluated financial burden associated with acute cardiovascular events and comparative healthcare expenditures between DM and ASCVD, less is known about the expressed financial hardship and inability to pay medical bills for individuals with families on the basis of ASCVD and DM status.
Methods:
Using data from the National Information Survey between 2013 and 2017, we examined ASCVD/DM status, financial hardship from medical bills, and an inability to pay medical bills at all for a nationally representative sample of non-elderly adults in the United States between 18-64 years of age.
Results:
Our study population consisted of 121,672 individuals. Approximately 3.1% of the weighted population had ASCVD alone, 5.6% had diabetes alone, and 1.3% had both ASCVD and diabetes mellitus. Nearly 50% of individuals with both ASCVD and DM reported having financial hardship from medical bills (23% being unable to pay medical bills at all) as compared to 28% of those without ASCVD and DM reported financial hardship from medical bills (8% being unable to pay medical bills at all). Individuals having ASCVD concurrently with DM had higher odds of expressing inability to pay medical bills at all when compared to those with DM alone (OR 2.69, 95% CI [2.21, 3.28] vs OR 1.70, 95% CI [1.52, 1.91]) whereas it was not significant when compared to those with ASCVD alone (OR 1.97, 95% CI [1.72, 2.25]).
Conclusion:
Patients with ASCVD and concurrent DM have much higher risk of financial hardship from medical bills compared to individuals with neither ASCVD nor DM. These findings provide strong evidence for clinicians to address these co-morbidities concurrently, particularly among vulnerable populations with limited financial means, emphasizing the importance of primary and secondary prevention along with appropriate lifestyle and therapeutic management.
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Affiliation(s)
- Reed Mszar
- Yale Sch of Public Health, New Haven, CT
| | - Gowtham R Grandhi
- Cntr for Outcomes Rsch and Evaluation, Yale New Haven Hosp, New Haven, CT
| | | | - Rohan Khera
- Univ of Texas Southwestern Med Cntr, Dallas, TX
| | | | | | | | | | - Khurram Nasir
- Cntr for Outcomes Rsch and Evaluation, Yale New Haven Hosp, New Haven, CT
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Muniyappa R, Tella SH, Sortur S, Mszar R, Grewal S, Abel BS, Auh S, Chang DC, Krakoff J, Skarulis MC. Predictive Accuracy of Surrogate Indices for Hepatic and Skeletal Muscle Insulin Sensitivity. J Endocr Soc 2018; 3:108-118. [PMID: 30675598 DOI: 10.1210/js.2018-00206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 07/08/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022] Open
Abstract
Context Surrogate indices of muscle and hepatic insulin sensitivity derived from an oral glucose tolerance test (OGTT) are frequently used in clinical studies. However, the predictive accuracy of these indices has not been validated. Design In this cross-sectional study, hyperinsulinemic-euglycemic glucose clamp with tritiated glucose infusion and a 75-g OGTT were performed in individuals (n = 659, aged 18 to 49 years, body mass index of 16 to 64 kg/m2) with varying degrees of glucose tolerance. A calibration model was used to assess the ability of OGTT-derived, tissue-specific surrogate indices [hepatic insulin resistance index (HIRI) and muscle insulin sensitivity index (MISI)] to predict insulin sensitivity/resistance indices derived from the reference glucose clamp [Hepatic-IRbasal, a product of fasting plasma insulin and hepatic glucose production (HGP), Hepatic-IRclamp, reciprocal of the percent suppression of HGP during the insulin clamp corrected for plasma insulin concentration, and Muscle-ISclamp, a measure of peripheral glucose disposal]. Predictive accuracy was assessed by root mean squared error of prediction and leave-one-out, cross-validation-type square root of the mean squared error of prediction. Results HIRI and MISI were correlated with their respective clamp-derived indices. HIRI was negatively related to Muscle-ISclamp (r = -0.62, P < 0.0001) and MISI correlated with Hepatic-IR derived from the clamp (Hepatic-IRbasal: r = -0.48, P < 0.0001 and Hepatic-IRclamp: r = -0.41, P < 0.0001). However, the accuracy of HIRI and MISI to predict Hepatic-IR (basal or during clamp) was not significantly different. Likewise, the ability of HIRI and MISI to predict Muscle-ISclamp was also similar. Conclusion Our findings indicate that the surrogate indices derived from an OGTT are accurate in predicting insulin sensitivity but are not tissue specific.
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Affiliation(s)
- Ranganath Muniyappa
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sri Harsha Tella
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Shrayus Sortur
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Reed Mszar
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Shivraj Grewal
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brent S Abel
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sungyoung Auh
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Douglas C Chang
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Jonathan Krakoff
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Monica C Skarulis
- Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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