Abstract / Description:

Influenza places a significant health burden on the US population, resulting in an estimated 140,000-810,000 hospitalizations and 12,000-61,000 deaths annually.1 Influenza is associated with acute cardiovascular events, including heart failure exacerbations,2 ischemic episodes,2 and overall cardiovascular mortality, even in people with no prior cardiac history.3 In individuals with cardiovascular risk factors who become infected with influenza, there is a significant association between influenza and acute myocardial infarction.4

Category: General CV

Date: 2020

Author: Sallyann Coleman King, MD; Amy Parker Fiebelkorn, MSN, MPH; Laurence S. Sperling, MD, FACC

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Abstract / Description:

The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help diagnose and manage their patientsí high BP. These resources are available to all physicians and health systems as part of?Target: BPô, a national initiative co-led by the AMA and American Heart Association (AHA). Now is the time to fight back harder with better tools. This brief glossary will help guide you through different terms to make strides in improving blood pressure control.

Category: General CV

Date: 2020

Author: Sara Berg

Abstract / Description:

Why can heart attacks strike people who appear to be perfectly healthy? In some cases, the answer is a little-known risk, lipoprotein(a), which is rarely considered until its impact is felt. Here are 10 things to know about this quiet threat.

Category: General CV

Author: N/A

Abstract / Description:

Health equity is where everyone has a fair and just opportunity to live their healthiest life possible. But health inequity remains. Now the COVID-19 pandemic is worsening historical inequities, and disproportionately affecting and killing Latinos and other people of color. So what can we do? We need to both immediate focus to ease the coronavirus pandemic and its impact on Latinos and people of color, as well as long-term strides to address underlying inequities that are aggravated during this time. It won’t be easy, or fast. But here’s few ways to push for health equity.

Category: COVID-19 Impact on Minority Health, Hispanic/Latino

Date: 2020

Author: Amelie Ramirez

Abstract / Description:

This publication describes uniform definitions for cardiovascular and stroke outcomes developed by the Standardized Data Collection for Cardiovascular Trials Initiative and the U.S. Food and Drug Administration (FDA). The FDA established the Standardized Data Collection for Cardiovascular Trials Initiative in 2009 to simplify the design and conduct of clinical trials intended to support marketing applications. The writing committee recognizes that these definitions may be used in other types of clinical trials and clinical care processes where appropriate.

Category: Clinical trials

Date: 2018

Author: Karen A. Hicks, Kenneth W. Mahaffey, Roxana Mehran, Steven E. Nissen, Stephen D. Wiviott, Billy Dunn, Scott D. Solomon, John R. Marler, John R. Teerlink, Andrew Farb, David A. Morrow, Shari L. Targum, Cathy A. Sila, Mary T. Thanh Hai, Michael R. Jaff, Hylton V. Joffe, Donald E. Cutlip, Akshay S. Desai, Eldrin F. Lewis, C. Michael Gibson, Martin J. Landray, A. Michael Lincoff, Christopher J. White, Steven S. Brooks, Kenneth Rosenfield, Michael J. Domanski, Alexandra J. Lansky, John J.V. McMurray, James E. Tcheng, Steven R. Steinhubl, Paul Burton, Laura Mauri, Christopher M. OíConnor, Marc A. Pfeffer, H.M. James Hung, Norman L. Stockbridge, Bernard R. Chaitman, Robert J. Temple, on behalf of the Standardized Data Collection for Cardiovascular Trials Initiative (SCTI), Heather D. Fitter, Kachikwu Illoh, Kenneth J. Cavanaugh Jr., Benjamin M. Scirica, Ilan Irony, Rachel E. Brown Kichline, Jonathan G. Levine, Anna Park, Leonard Sacks, Ana Szarfman, Ellis F. Unger, Lori Ann Wachter, Bram Zuckerman, Yale Mitchel, Douglas Peddicord, Thomas Shook, Bron Kisler, Charles Jaffe, Rhonda Bartley, David L. DeMets, MariJo Mencini, Cheri Janning, Steve Bai, John Lawrence, Ralph B. DíAgostino Sr. and Stuart J. Pocock

Abstract / Description:

N/A

Category: General CV

Date: 2018

Author: Alliance for Patient Access

Abstract / Description:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Most individuals who develop ASCVD have at least 1 antecedent major risk factor, and very few have optimal levels of all risk factors and behavioral factors. Lifestyle and behavioral factors are the foundation of ASCVD prevention, and maintaining healthy habits can help preserve good cardiovascular health over the life course. The key to effective prevention is a comprehensive approach, emphasizing a healthy lifestyle and addressing all major risk factors. The 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease incorporates existing guidelines, statements, and consensus documents into a single comprehensive resource for patients, health care professionals, and public health officials.1 Recommendations to prevent ASCVD (coronary heart disease, stroke, and peripheral artery disease), atrial fibrillation, and heart failure in adults include lifestyle factors (eg, nutrition, exercise or physical activity, overweight and obesity, and tobacco use) and treatment-associated factors (eg, risk assessment, blood pressure level, blood cholesterol level, diabetes, and aspirin use). This article focuses on lifestyle factors.

Category: General CV

Date: 2019

Author: Donna K. Arnett, PhD, MSPH1; Amit Khera, MD, MSc2; Roger S. Blumenthal, MD3

Abstract / Description:

2019 Heart Disease & Stroke Statistical Update Fact Sheet Hispanics/Latinos & Cardiovascular Diseases

Category: Hispanic/Latino

Date: 2020

Author: American Heart Association

Category: Asian/Pacific Islander CV

Date: 2019

Author: American Heart Association

Abstract / Description:

CCDs arise from abnormal formation of the heart or major blood vessels. CCDs range in severity from very minor abnormalities that will never require medical therapy or intervention to complex malformations, including absent or atretic portions of the heart, that could require multiple surgeries and interventions, or even cardiac transplantation. Thus, there is significant variability in their presentation and requirements for care that can have a significant impact on morbidity, mortality, and healthcare costs in children and adults.

Category: General CV

Date: 2019

Author: American Heart Association

Abstract / Description:

Recent polling on coronavirus-related unemployment is illuminating alarming statics — mainly, Latinos are bearing the burden of the economic tidal wave impacting the U.S.

Category: COVID-19 Impact on Minority Health, Hispanic/Latino

Date: 2020

Author: Josh McCormack

A

Abstract / Description:

PURPOSE: Independent and combined effects of air pollution and psychosocial stressors on hypertension, a risk factor for cardiovascular disease, among Hispanics are not well studied. METHODS: We administered a pilot-tested questionnaire on individual- and neighborhood-level psychosocial stressors, developed with community input, to nearly 2500 individuals from the MD Anderson Cancer Center cohort of Mexican-Americans. We used data from local air quality monitors to estimate individual exposures to ozone (O3) and fine particulate matter (PM2.5) for the 12-month period preceding enrollment using inverse distance interpolation. We applied logistic regression models to examine relationships between exposures to psychosocial stressors and air pollution with prevalent hypertension and used stratified analyses to examine the interacting effects of these two exposures on hypertension. RESULTS: There was a positive association between prevalent hypertension and a high frequency of feeling anxious or depressed (prevalence odds ratio (POR)?=?1.36, 95% CI [1.06-1.75]) and experiencing aches and pains (POR?=?1.29, 95% CI [1.01-1.64]). The odds of having hypertension were also elevated among those worrying about their own health (POR?=?1.65, 95% CI [1.30-2.06]) or about not having enough money (POR?=?1.27, 95% CI [1.01-1.6]). We observed an inverse association between O3 and hypertension. There was no interaction between psychosocial stressors and O3 on hypertension. CONCLUSION: Our findings add to the evidence of a positive association between individual and family stressors on hypertension among Hispanics and other racial/ethnic groups. Contrary to previous studies reporting positive associations, our results suggest that long-term exposure to O3 may be inversely related to prevalent hypertension. KEYWORDS: Air pollution; Hypertension; Mexican-origin Hispanics; Psychosocial stress

Category: Hispanic/Latino

Date: 2018

Author: Amal Rammah, Kristina Walker Whitworth, Inkyu Han, Wenyaw Chan, Maria D. Jimenez, Sara S. Strom, Melissa L. Bondy & Elaine Symanski

Abstract / Description:

Vapes can expose you to toxic chemicals like formaldehyde and acrolein , even if they don't have nicotine

Category: Tobacco

Author: FDA Tabacco Education Resources

Abstract / Description:

Importance There is increasing interest in the effect of cardiovascular disease on cancer survivors. However, there are limited contemporary population-based data on the risk of cardiovascular death after early-stage breast cancer. Objective To describe the incidence of cardiovascular death in a contemporary population of women with early-stage breast cancer while accounting for competing risks. Design, Setting, and Participants A population-based cohort study was conducted among 98?999 women diagnosed with early-stage breast cancer between April 1, 1998, and March 31, 2012. Patients were followed up until death or were censored on December 31, 2013. Baseline characteristics were determined from administrative databases and the Ontario Cancer registry. Vital statistics data were used to determine the cause of death. Cumulative incidence functions were used to estimate the incidence of cause-specific mortality. We studied the association between baseline characteristics and rates of cardiovascular death using cause-specific hazard functions. The analyses accounted for competing risks of noncardiovascular death. Statistical analysis was performed from July 16, 2015, to August 4, 2016. Exposures Early-stage breast cancer, age, cardiovascular disease, hypertension, and diabetes. Main Outcomes and Measures Cause of death, which was classified as breast cancer, cardiovascular disease, other cancers, or other noncancer causes. Results Of the 98?999 women (median age, 60 years [interquartile range, 50-71 years]) in the study, 21?123 (21.3%) died during follow-up. The median time to death was 4.2 years (IQR, 2.2-7.1 years). Breast cancer was the most common cause of death (10?550 deaths [49.9%]); 3444 deaths [16.3%] were from cardiovascular causes. Cardiovascular death was infrequent in women younger than 66 years without prior cardiovascular disease, diabetes, or hypertension. Among women 66 years or older, the risks of breast cancer death and cardiovascular death at 10 years were 11.9% (95% CI, 11.6%-12.3%) and 7.6% (95% CI, 7.3%-7.9%), respectively. Among patients with prior cardiovascular disease, the risk of death from breast cancer and cardiovascular disease were equivalent for the first 5 years, after which death from cardiovascular causes was more frequent (10-year cumulative incidence, 14.6% [95% CI, 13.7%-15.4%] for breast cancer vs 16.9% [95% CI, 16.0%-17.8%] for cardiovascular disease). For women 66 years or older who survived 5 years or more after diagnosis of breast cancer, cardiovascular disease exceeded breast cancer as the leading cause of death at 10 years after diagnosis, when the cumulative incidence of each was 5%. Conclusions and Relevance Cardiovascular death is an important competing risk for older women with early-stage breast cancer. This finding mandates adequate attention to cardiovascular preventive therapy after diagnosis of breast cancer.

Category: Cardio-Oncology

Date: 2017

Author: Husam Abdel-Qadir, MD; Peter C. Austin, PhD; Douglas S. Lee, MD, PhD; Eitan Amir, MB, ChB, PhD; Jack V. Tu, MD, PhD; Paaladinesh Thavendiranathan, MD, MS; Kinwah Fung, MS; Geoffrey M. Anderson, MD, PhD

Abstract / Description:

Amid the dual crises of a global pandemic and a reckoning with systemic racial injustice, health workers and health educators are grappling with a momentous question that hovers between personal and professional: how much of an activist should a health care worker be? Doctors, epidemiologists, and nurses are increasingly abandoning their characteristic reticence in favor of direct advocacy. They raised early alarms, in op-eds and on cable news programs, about the disproportionate toll the Covid-19 pandemic was taking on communities of color. In the wake of the killing of George Floyd, the activism has intensified: they are circulating petitions, ramping up educational outreach, and organizing sit-ins to fight police brutality and systemic racism. They are joining marches and organizing their own; more than 10,000 health care workers donned their white coats and scrubs to march through downtown Seattle to show their support for the Black Lives Matter movement.

Category: Racism and Health

Date: 2020

Author: RUTH HAILU

Abstract / Description:

Tanefer Camara had no intention of giving birth at home. She’d planned, with her midwife, to do it in a hospital. But at 38 weeks, she went into labor. When she called her midwife to say she thought it was time to go to the hospital, the midwife dismissed her, telling her to wait a little longer at home. Camara then found herself sprawled on her bed with the uncontrollable urge to push. Assisted only by her husband and then-6-year-old son, she gave birth to a daughter within 30 minutes, covering her bed in blood and other fluids. “I was not prepared for a home birth,” Camara, who’s a lactation consultant in Oakland, California, said. Her husband had to scramble to find something to tie the umbilical cord. He used a shoelace. On the way to the hospital, Camara developed blood clots. When she arrived, she was hemorrhaging and had to take medication to stop the bleeding. In the end, she and her daughter were healthy. But “every step of the way, I had to advocate for myself,” she said. “If I didn’t have the knowledge that I had around pregnancy, birth, and breastfeeding, it could have been a lot worse.”

Category: Racism and Health

Date: 2019

Author: Julia Belluz

Abstract / Description:

Background Atrial fibrillation is a major public health problem and is the most common cardiac arrhythmia, affecting an estimated 2.7 million Americans. The true prevalence of atrial fibrillation is likely underestimated because episodes are often sporadic; therefore, it is challenging to detect and record an occurrence in a “real world” setting. To date, mobile health tools that promote earlier detection and treatment of atrial fibrillation and improvement in self-management behaviors and knowledge have not been evaluated. This study will be the first to address the epidemic problem of atrial fibrillation with a novel approach utilizing advancements in mobile health electrocardiogram technology to empower patients to actively engage in their healthcare and to evaluate impact on quality of life and quality-adjusted life years. Furthermore, sending a daily electrocardiogram transmission, coupled with receiving educational and motivational text messages aimed at promoting self-management and a healthy lifestyle may improve the management of chronic cardiovascular conditions (e.g., hypertension, diabetes, heart failure, etc.). Therefore, we are currently conducting a randomized controlled trial to assess the efficacy of a mobile health intervention, iPhone® Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART) versus usual cardiac care. Methods The iHEART study is a single center, prospective, randomized controlled trial. A total of 300 participants with a recent history of atrial fibrillation will be enrolled. Participants will be randomized 1:1 to receive the iHEART intervention, receiving an iPhone® equipped with an AliveCor® Mobile ECG and accompanying Kardia application and behavioral altering motivational text messages or usual cardiac care for 6 months. Discussion This will be the first study to investigate the utility of a mobile health intervention in a “real world” setting. We will evaluate the ability of the iHEART intervention to improve the detection and treatment of recurrent atrial fibrillation and assess the intervention's impact on improving clinical outcomes, quality of life, quality-adjusted life-years and disease-specific knowledge.

Category: Telehealth

Date: 2016

Author: Kathleen T. Hickey,corresponding author Nicole R. Hauser, Laura E. Valente, Teresa C. Riga, Ashton P. Frulla, Ruth Masterson Creber, William Whang, Hasan Garan, Haomiao Jia, Robert R. Sciacca, and Daniel Y. Wang

Abstract / Description:

Background:Mental health and HIV disparities are well documentedamongsexualminorities,butthereisa dearthofresearchonotherchronicconditions. Cardiovascular disease remains the leading cause of deathworldwide. Although sexual minorities have high rates of several modi-fiable risk factors for cardiovascular disease (including stress, tobacco use,and alcohol consumption), there is a paucity of research in this area.Objectives:In this systematic review, we synthesized and critiqued theexisting evidence on cardiovascular disease among sexual minority adults.Search Methods:We conducted a thorough literature search of 6electronic databases for studies published between January 1985 andDecember 2015 that compared cardiovascular disease risk or prevalencebetween sexual minority and heterosexual adults.Selection Criteria:We included peer-reviewed English-language studiesthat compared cardiovascular disease risk or diagnoses between sexualminority and heterosexual individuals older than 18 years. We excludedreviews, case studies, and gray literature. A total of 31 studies met in-clusion criteria.Data Collection and Analysis:At least 2 authors independently ab-stracted data from each study. We performed quality assessment ofretrieved studies using the Crowe Critical Appraisal Tool.Main Results:Sexual minority women exhibited greater cardiovas-cular disease risk related to tobacco use, alcohol consumption, illicitdrug use, poor mental health, and body mass index, whereas sexualminority men experienced excess risk related to tobacco use, illicitdrug use, and poor mental health. We identified several limitations inthe extant literature. The majority of included studies were cross-sectional analyses that used self-reported measures of cardiovasculardisease. Even though we observed elevated cardiovascular diseaserisk, we found few differences in cardiovascular disease diagnoses(including hypertension, diabetes,and high cholesterol). Overall, 23of the 26 studies that examined cardiovascular disease diagnosesused subjective measures. Only 7 studies used a combination ofbiomarkers and self-report measures to establish cardiovasculardisease risk and diagnoses.AuthorsíConclusions:Social conditions appear to exert a negativeeffect on cardiovascular disease risk among sexual minorities. Al-though we found few differences in cardiovascular disease diagnoses,we identified an elevated risk for cardiovascular disease in both sexualminority men and women. There is a need for research that in-corporates subjective and objective measures of cardiovasculardisease risk.Public Health Implications:Cardiovascular disease is a major healthconcern for clinicians, public health practitioners, and policymakers. Thissystematic review supports the need for culturally appropriate in-terventions that address cardiovascular disease risk in sexual minorityadults.

Category: General CV

Date: 2017

Author: Billy A. Caceres MSN, RN-BC, Abraham Brody RN, PhD, Rachel E. Luscombe BSN, Jillian E. Primiano BSN, Peter Marusca BSN, Edward M. Sitts BSN, and Deborah Chyun RN, PhD

Abstract / Description:

bstract Background: Risk assessment is the cornerstone for guiding atherosclerotic cardiovascular disease (ASCVD) treatment decisions. Machine learning methods and electronic health record (EHR) data offer great promise in the development of novel risk prediction models. Methods: We used EHR data from a community-based, outpatient healthcare system in Northern California from 2006 to 2018. Patients were free of prior ASCVD, were not on statins, and had at least 5 years of follow-up. We used random forests (RF) and gradient boosting models (GBM) to develop tree-based classifiers to predict ASCVD risk. We calculated risk using the pooled cohort equations (PCE) by considering patients with complete data within the pre-specified ranges. We then allowed our tree-based models access to additional patients with missing variables, and additional variables from the EHR (e.g. weight, education, medications), and compared model performance. Results: Our study cohort consisted of 292,758 eligible patients with ?5 years of follow-up; 2,022 had ASCVD events. Among the 148,141 patients with complete data for the PCE, the C-statistics of GBM and RF were statistically significantly higher than that of the PCE (Figure). When we trained on the complete patient cohort but restricted to variables used in the PCE, the C-statistics of recalibrated logistic regression, GBM, and RF all improved significantly to values between 0.812 and 0.817. With inclusion of additional EHR variables, GBM (C-statistic 0.818 ± 0.016) and RF (C-statistic: 0.811 ± 0.016) had significantly better performance than that of recalibrated logistic regression (C-statistic: 0.774 ± 0.016). Conclusion: Cardiovascular risk prediction improved significantly with the inclusion of more patients and more variables and with the use of machine learning algorithms. Machine learning models developed using data from more patients and additional variables may improve ASCVD risk assessment.

Category: General CV

Date: 2019

Author: Andrew Ward, Ashish Sarraju, Sukyung Chung, Latha Palaniappan, David Scheinker, Fatima Rodriguez,

Abstract / Description:

Introduction: Atrial fibrillation is a major cause of morbidity and mortality in the United States. Ensuring racial/ethnic diversity in clinical trial participation is vital for generalizability of atrial fibrillation therapies and practice guidelines. Methods: We identified clinical trials cited in the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for Atrial Fibrillation. We examined published manuscripts and supplementary data for participant racial/ethnic data. We classified studies by reported proportion of non-Hispanic white (NHW), African-American, Hispanic, and/or Asian participants. For each race/ethnicity, we pooled trial data to determine overall percentage of participation. We also classified studies by whether they reported geographic areas (North America, Europe, Latin America, and Asia-Pacific). Results: We identified 28 trials published between 1996 and 2019. Only 10 studies (36%) explicitly reported participant level racial/ethnic data. An additional 7 trials reported geographic areas. All 10 studies reporting participant data were published between 2010 and 2019. Among these, 88.6% of participants were identified as NHW. Only 6 studies reported African-American participants (pooled proportion 2%), 5 reported Hispanic participants (pooled proportion 5.8%), and 5 reported Asian participants (pooled proportion 10.6%). African Americans and Hispanics were under-represented in clinical trials compared to the US population per 2018 census data (Figure). Conclusions: Participant level racial/ethnic data are under-reported in guideline-informing atrial fibrillation clinical trials. In trials reporting participant level data, African-American and Hispanic populations are under-represented. These factors may limit generalizability of trial results and practice guidelines across diverse groups. Future trials should focus on improving reporting and participation of racial/ethnic minorities.

Category: Equity

Date: 2019

Author: Ashish Sarraju, David J Maron, Fatima Rodriguez

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Abstract / Description:

rushing your teeth twice a day for at least two minutes may lower the risk of cardiovascular diseases, a new study suggests. Previous studies have found a link between heart disease and periodontal disease ñ a condition marked by gum infection, gum inflammation and tooth damage. The new study, being presented Saturday at the American Heart Association's Scientific Sessions meeting in Chicago, looked at whether a person's tooth-brushing habits were associated with their risk of having or dying from a heart attack, heart failure or stroke.

Category: Oral Health

Date: 2018

Author: American Heart Association

Abstract / Description:

Introduction and Goal: Stroke is a serious health condition that disproportionally affects African-Americans relative to non-Hispanic whites. In the absence of clearly defined reasons for racial disparities in stroke recovery and subsequent stroke outcomes, a critical first step in mitigating poor stroke outcomes is to explore potential barriers and facilitators of poststroke recovery in African-American adults with stroke. The purpose of this study was to qualitatively explore poststroke recovery across the care continuum from the perspective of African-American adults with stroke, caregivers of African-American adults with stroke, and health care professionals with expertise in stroke care. Materials and Methods: This qualitative descriptive study included in-depth key informant interviews with health care providers (n?=?10) and focus groups with persons with stroke (n?=?20 persons) and their family members or caregivers (n?=?19 persons). Data were analyzed using thematic analysis according to the Social Ecological Model, using both inductive and deductive approaches. Findings: Persons with stroke and their caregivers identified social support, resources, and knowledge as the most salient factors associated with stroke recovery. Perceived barriers to recovery included: (1) physical and cognitive deficits, mood; (2) medication issues; (3) lack of support and resources; (4) stigma, culture, and faith. Health care providers identified knowledge/information, care coordination, and resources in the community as key to facilitating stroke recovery outcomes. Conclusions: Key findings from this study can be incorporated into interventions designed to improve poststroke recovery outcomes and potentially reduce the current racial-ethnic disparity gap.

Category: Black/African American CV

Date: 2019

Author: Gayenell S. Magwood, PhD, RN, FAHA, FAAN Charles Ellis, PhD, CCC-SLP Michelle Nichols, PhD, RN Suzanne Perea Burns, PhD, OTR/L Carolyn Jenkins, DrPH, RN, RD, LD, FAAN Michelle Woodbury, PhD, OTR/L Robert Adams, MS, MD

Abstract / Description:

INTRODUCTION AND GOAL: Stroke is a serious health condition that disproportionally affects African-Americans relative to non-Hispanic whites. In the absence of clearly defined reasons for racial disparities in stroke recovery and subsequent stroke outcomes, a critical first step in mitigating poor stroke outcomes is to explore potential barriers and facilitators of poststroke recovery in African-American adults with stroke. The purpose of this study was to qualitatively explore poststroke recovery across the care continuum from the perspective of African-American adults with stroke, caregivers of African-American adults with stroke, and health care professionals with expertise in stroke care. MATERIALS AND METHODS: This qualitative descriptive study included in-depth key informant interviews with health care providers (n?=?10) and focus groups with persons with stroke (n?=?20 persons) and their family members or caregivers (n?=?19 persons). Data were analyzed using thematic analysis according to the Social Ecological Model, using both inductive and deductive approaches. FINDINGS: Persons with stroke and their caregivers identified social support, resources, and knowledge as the most salient factors associated with stroke recovery. Perceived barriers to recovery included: (1) physical and cognitive deficits, mood; (2) medication issues; (3) lack of support and resources; (4) stigma, culture, and faith. Health care providers identified knowledge/information, care coordination, and resources in the community as key to facilitating stroke recovery outcomes. CONCLUSIONS: Key findings from this study can be incorporated into interventions designed to improve poststroke recovery outcomes and potentially reduce the current racial-ethnic disparity gap.

Category: Stroke

Date: 2019

Author: Gayenell S. Magwood, PhD, RN, FAHA, FAAN, Charles Ellis, PhD, CCC-SLP, Michelle Nichols, PhD, RN, Suzanne Perea Burns, PhD, OTR/L, Carolyn Jenkins, DrPH, RN, RD, LD, FAAN, Michelle Woodbury, PhD, OTR/L,Robert Adams, MS, MD

Abstract / Description:

Objective:†We surveyed obstetric sonographers to determine how barriers to prenatal cardiac screening impacted screening abilities.†Methods:†We performed a cross-sectional national survey of obstetric sonographers in the United States using a sampling frame from American Registry of Diagnostic Medical Sonography mailing lists. The web survey measured the ability to obtain and interpret fetal heart images. Several cognitive, sociodemographic, and system-level factors were measured, including intention to perform cardiac imaging. Regression and mediation analyses determined factors associated with intention to perform and ability to obtain and interpret cardiac images. Subgroup analyses of sonographers in tertiary versus nontertiary centers were also performed.†Conclusions:†We identified several modifiable (some heretofore unrecognized) targets to improve prenatal cardiac screening. Priorities identified by sonographers that are associated with screening success should guide future interventions.

Category: Cardio-Obstetrics

Date: 2019

Author: Pinto N.M.; Henry K.A.; Wei G.; Sheng X.; Green T.; Puchalski M.D.; Byrne J.L.B.; Kinney A.Y.

Abstract / Description:

Abstract In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD?related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population?wide basis. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States.1 Despite significant progress in the past 40 years,2 reductions in the CVD mortality rate have slowed after 4 decades of decline; between 2010 and 2015, CVD deaths increased, although the age?adjusted death rate declined by 1.8% between 2015 and 2016.3 Arnett et al4 attributed the deceleration in CVD mortality decline to increasing obesity prevalence, which is a direct result of suboptimal dietary habits. In the United States, approximately half of all CVD?related disability and death is attributed to poor diet quality, making it the leading cause of CVD.1 Disparities in diet quality exist by race, ethnicity, and socioeconomic status (SES).3, 5, 6 Diet?related disparities mirror the disproportionate burden of CVD in underserved populations.3 The purpose of this article is to summarize the disparities in diet quality that exist in the United States as it relates to CVD, and discuss barriers and strategies to improve overall diet quality with a focus on the social determinants of CVD and poor diet quality.

Category: General CV

Date: 2020

Author: Penny M. Kris?Etherton , PhD, RDN, Kristina S. Petersen , PhD, APD, Gladys Velarde, MD, Neal D. Barnard, MD, Michael Miller, MD, Emilio Ros, MD, PhD, James H. O'Keefe, MD, Kim WilliamsSr., MD, MACC, Linda Van Horn, PhD, RDN, Muzi Na, PhD, MHS, Christina Shay, PhD, Paul Douglass, MD, David L. Katz, and MD, MPH, and Andrew M. Freeman MD

Abstract / Description:

Coronavirus disease 2019 (COVID‐19) is an infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). On March 11, 2020, the World Health Organization (WHO) declared the COVID‐19 outbreak a pandemic. Currently, the United States has the highest number of officially reported COVID‐19 cases and deaths in the world. As of April 6, 2020, more than two‐thirds of rural US counties had been affected, including the rural southeastern states where lockdowns had been delayed.1, 2 Although all population groups are affected, racial/ethnic minorities have borne the brunt of the pandemic, especially African Americans.2 In Louisiana, 72% of deaths related to COVID‐19 are African Americans, who comprise only 32% of the population.3 Similar disproportionately high death rates in African American communities are being reported in other states like Illinois, Wisconsin, Michigan, and North Carolina.4  

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Lakshay Sood, Vanita Sood MD

Abstract / Description:

Introduction: This exercise is a small-group discussion about bias for medical students who have had at least some clinical experience. It is designed to cultivate awareness that bias is inherent in all humans, including physicians, and can impact patient care. The aim is to foster self-reflection through an exercise that challenges assumptions about personal bias. Methods: The Implicit Association Test (IAT) is used as a trigger, and a small-group discussion format is used to create reflection about personal biases and their effects on clinical decisions. Students discuss what it was like to take the IAT, how they felt when they got their results, if their results were expected, when bias can be helpful, clinical experiences with bias, and what they will do with their results. The content is presented as a set of guidelines and features materials for training facilitators and conducting the discussion. These materials comprise an outline of the exercise, advance preparation assignments, instructions for students, and a small-group facilitator guide. The materials also include evaluation tools consisting of pre- and postdiscussion student surveys and facilitator postdiscussion surveys. Results: As evidence that the IAT does generate meaningful discussion in a facilitated small group, we report the analysis of our pilot data (n = 72). Our exercise resulted in an increase in the perception that personal bias could have an impact on patient relationships (p < .001) among students reporting a lower belief that bias can have impact (n = 6). Among students who rated themselves as having a lower self-awareness prior to the exercise (n = 14), there was an increase in self-awareness of personal bias after the exercise (p < .001). Finally, students reported significant increases (p < .01) in the perception that the IAT was an effective tool for generating small-group discussion about personal bias (p < .001) and that the reflection exercises and small-group discussions were effective tools for raising awareness about personal bias (p < .001) after attending the session. Discussion: Our results suggest that the primary value of this exercise lies not simply in taking the IAT but rather in the cognitive processing of the IAT and other potential biases that takes place during the small-group session. The IAT in conjunction with the discussion appears to be what leads to increased self-awareness and self-reflection.

Category: Medical Education

Date: 2010

Author: Anne Gill, DrPH, Britta Thompson, PhD, Cayla Teal, PhD, Rachel Shada, MHR, Ernest Fruge, PhD, Gracielia Villarreal, MD, Cindy Patton, MS, Paul Haidet, MD, MPH

Abstract / Description:

The Best Practices Guide for CVD Prevention describes and summarizes scientific evidence behind 8 effective strategies for lowering high blood pressure and cholesterol levels that can be implemented in health care systems and that involve community-clinical links. The guide is a resource for state and local health departments, decision makers, public health professionals, and other stakeholders interested in using proven strategies to improve cardiovascular health.

Category: General CV

Date: 2018

Author: Centers for Disease Control and Prevention (CDC)

Abstract / Description:

CVD is the leading cause of maternal deaths in the U.S., contributing to a more than twofold increase in pregnancy-related mortality from 1987 to 2015, and better CV management in pregnant women is needed, according to a presenter. Additionally, Black women experienced a more than threefold greater risk for pregnancy-related mortality compared with white or non-Hispanic women, Renee P. Bullock-Palmer, MD, FACC, FAHA, FASNC, FASE, FSCCT, director of the Women’s Heart Center at the Deborah Heart and Lung Center in Browns Mills, New Jersey, said during a presentation at the American Society for Preventive Cardiology Congress on CVD Prevention.

Category: Cardio-Obstetrics

Date: 2020

Author: Scott Buzby

Abstract / Description:

In the United States, hypertension is a significant medical problem that affects nearly 1 in 3 adults, causes thousands of deaths annually, and costs the nation billions of dollars annually for medical management in terms of hospitalisations, lost wages, and pharmacotherapy. The management guidelines of hypertension have greatly varied between different healthcare organisations including the American College of Cardiology (ACC), the European Society of Cardiology (ESC) and the Joint National Committee (JNC-7, 8). One of the points of contention is the generalisability of the guidelines to all individuals despite empirical evidence suggesting racial sensitivities to pharmacotherapy and high clinical adversities with elevations in blood pressure (BP). This manuscript will aim to review a brief history of the guidelines, the adjustment of the BP goals with pharmacotherapy for the management of hypertension, and discuss several socioeconomic factors attributing to higher clinical risks for certain minority racial groups susceptible to the new BPs goals for management under the JNC-8.

Category: General CV

Date: 2018

Author: Burns J1, Persaud-Sharma D1, Green D1,2.

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Abstract / Description:

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need. Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research.

Category: Asian/Pacific Islander CV

Date: 2010

Author: Latha P. Palaniappan, Maria Rosario G. Araneta, Themistocles L. Assimes, Elizabeth L. Barrett-Connor, Mercedes R. Carnethon, Michael H. Criqui, Gordon L. Fung, K.M. Venkat Narayan, Hamang Patel, Ruth E. Taylor-Piliae, Peter W.F. Wilson, Nathan D. Wong, and and on behalf of the American Heart Association Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, Council on Nutrition, Physical Activity, and Metabolism, Council on Clinical Cardiology, and Council on Cardiovascular Nursing

Abstract / Description:

Two new studies report that minorities are much more likely to access mHealth information on smartphones.This may be the link doctors need to create effective population health outreach. Healthcare providers looking to connect with minorities should develop an mHealth strategy that focuses on the smartphone. Thatís the takeaway from a pair of studies published this month in the American Journal of Managed Care. The studies ñ one focusing on the variation of devices used to access patient portals and the other examining mobile access to personal health records ñ found that black and Hispanic populations use smartphones far more often than non-Hispanic whites to access mHealth data, and in many cases thatís the only device they use. The studies offer guidance on how to reach underserved populations, as well as offering a warning that mHealth programs now in place may be missing their target patients.

Category: Telehealth

Date: 2018

Author: Eric Wicklund

Abstract / Description:

CANCER TREATMENTS SAVE LIVES but sometimes also can damage your heart or blood vessels.

Category: Cardio-Oncology

Date: 2019

Author: Cardio Smart- American College of Cardiology

Abstract / Description:

The 5th World Symposium on Pulmonary Hypertension classified pulmonary hypertension (PH) into five groups of disorders: Group 1: Pulmonary arterial hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung disease and/or hypoxia Group 4: Chronic thromboembolic PH Group 5: PH due to unclear multifactorial mechanisms1 PH is also classified as pre-capillary and post-capillary based on hemodynamic data. The 6th World Symposium on Pulmonary Hypertension, recognizing that there can also be a combination of pre- and post-capillary PH, incorporated pulmonary vascular resistance (PVR) into the definition and emphasized the importance of differentiating between idiopathic pulmonary arterial hypertension (pre-capillary) and PH related to heart failure with preserved left ventricular (LV) ejection fraction (post-capillary) based on the pulmonary artery wedge pressure and PVR.2

Category: General CV

Date: 2020

Author: Timothy P. Obarski, DO, FACC

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Oscar Calvillo-Argüelles MD, Heather J. Ross MD MHSc

Abstract / Description:

Background Patients with muscular dystrophy (MD) represent a vulnerable patient population with no clearly defined care model in modern?day clinical practice to manage a high burden of heart disease and comorbidities. We demonstrate the effectiveness of cardiac interventions, namely the initiation and optimization of medical and device therapies, as part of a multidisciplinary care approach to improve clinical outcomes in patients with MD. Methods and Results We conducted a prospective cohort study at the Neuromuscular Multidisciplinary clinic following patients with dystrophinopathies, limb?girdle MD, type 1 myotonic dystrophy, and facioscapulohumeral MD. A negative control group classified as non?MD myopathies without heart disease, was also tracked. Our cohort of 185 patients (median age: 42 years; 79 [42.7%] women), included 145 patients with MD. Cardiomyopathy was present in 65.6% of the patients with dystrophinopathies (21 of 32) and 27.3% of the patients with limb?girdle MD (9 of 33). Conduction abnormalities were common in type 1 myotonic dystrophy (33.3% [20/60] patients). Cardiac intervention reversed systolic dysfunction, with left ventricular ejection fraction improving from 43% to 50.0% over a 3?year period. A sustained reduction in healthcare utilization was also observed. The number of outpatient clinic visits decreased from 3.0 to 1.5 visits per year, the duration of hospitalizations was reduced from 14.2 to 0.9 days per year, and the number of cardiac?related hospitalizations decreased from 0.4 to 0.1 hospitalizations per year associated with low mortality. Conclusions Our study demonstrates that cardiac intervention as part of a comprehensive multidisciplinary care approach to treating patients with MD leads to a sustained improvement in clinical outcomes.

Category: General CV

Date: 2020

Author: Anish Nikhanj, Haran Yogasundaram, Bailey Miskew Nichols, Janice Richman?Eisenstat, Cecile Phan, Jeffrey A. Bakal, Zaeem A. Siddiqi, and Gavin Y. Oudit

Abstract / Description:

Importance Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms. Design, Setting, and Participant This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course. Exposure Cardiac involvement with COVID-19. Main Outcomes and Measures Detection of cardiac involvement with an increase in levels of N-terminal proñbrain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging. Results An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptaseñpolymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization. Conclusions and Relevance This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Riccardo M. Inciardi, MD; Laura Lupi, MD; Gregorio Zaccone, MD; Leonardo Italia, MD; Michela Raffo, MD1; Daniela Tomasoni, MD1; Dario S. Cani, MD; Manuel Cerini, MD; Davide Farina, MD; Emanuele Gavazzi, MD; Roberto Maroldi, MD; Marianna Adamo, MD; Enrico Ammirati, MD, PhD; Gianfranco Sinagra, MD; Carlo M. Lombardi, MD; Marco Metra, MD

Abstract / Description:

Importance Trastuzumab is a life-saving therapy but is associated with symptomatic and asymptomatic left ventricular ejection fraction (LVEF) decline. We report the cardiac toxic effects of a nonanthracycline and trastuzumab-based treatment for patients with early-stage human epidermal growth factor receptor 2 (ERBB2, formerly HER2 or HER2/neu)-positive breast cancer. Objective To determine the cardiac safety of paclitaxel with trastuzumab and the utility of LVEF monitoring in patients with node-negative, ERBB2-positive breast cancer. Design, Setting, and Participants In this secondary analysis of an uncontrolled, single group study across 14 medical centers, enrollment of 406 patients with node-negative, ERBB2-positive breast cancer 3 cm, or smaller, and baseline LVEF of greater than or equal to 50% occurred from October 9, 2007, to September 3, 2010. Patients with a micrometastasis in a lymph node were later allowed with a study amendment. Median patient age was 55 years, 118 (29%) had hypertension, and 30 (7%) had diabetes. Patients received adjuvant paclitaxel for 12 weeks with trastuzumab, and trastuzumab was continued for 1 year. Median follow-up was 4 years. Interventions Treatment consisted of weekly 80-mg/m2 doses of paclitaxel administered concurrently with trastuzumab intravenously for 12 weeks, followed by trastuzumab monotherapy for 39 weeks. During the monotherapy phase, trastuzumab could be administered weekly 2-mg/kg or every 3 weeks as 6-mg/kg. Radiation and hormone therapy were administered per standard guidelines after completion of the 12 weeks of chemotherapy. Patient LVEF was assessed at baseline, 12 weeks, 6 months, and 1 year. Main Outcomes and Measures Cardiac safety data, including grade 3 to 4 left ventricular systolic dysfunction (LVSD) and significant asymptomatic LVEF decline, as defined by our study, were reported. Results Overall, 2 patients (0.5%) (95% CI, 0.1%-1.8%) developed grade 3 LVSD and came off study, and 13 (3.2%) (95% CI, 1.9%-5.4%) had significant asymptomatic LVEF decline, 11 of whom completed study treatment. Median LVEF at baseline was 65%; 12 weeks, 64%; 6 months, 64%; and 1 year, 64%. Conclusions and Relevance Cardiac toxic effects from paclitaxel with trastuzumab, manifesting as grade 3 or 4 LVSD or asymptomatic LVEF decline, were low. Patient LVEF was assessed at baseline, 12 weeks, 6 months, and 1 year, and our findings suggest that LVEF monitoring during trastuzumab therapy without anthracyclines could be simplified for many individuals. Introduction In the United States, breast cancer is the most common female cancer and the second most common cause of cancer death in women.1 Amplification or overexpression of the human epidermal growth factor receptor 2 (ERBB2, formerly HER2 or HER2/neu) oncogene is present in approximately 20% to 25% of primary invasive breast cancers.2 Trastuzumab has demonstrated a significant improvement in outcomes of women with early-stage breast cancer in key adjuvant trials, but most of these trials contained an anthracycline-based therapy followed by trastuzumab with or without a taxane in women with either node-positive or node-negative, high-risk breast cancer (usually defined as tumor size >1 cm or >2 cm).3-8 However, several studies from the pretrastuzumab era suggest a higher risk of recurrence for patients with ERBB2-positive, node-negative tumors compared with those with ERBB2-negative tumors of the same size.9-11 Recent retrospective studies have demonstrated a benefit from the combination of chemotherapy and trastuzumab in those with node-negative breast cancer and a time trend increase in the use of these agents.12-14 The most significant toxic effect of trastuzumab, especially following an anthracycline-based therapy, is symptomatic congestive heart failure (CHF) that has been reported from 0.9% to 4% and significant asymptomatic cardiac decline ranging from 4% to 19% in clinical trials.3-8,15-19 After the anthracycline phase, most symptomatic CHF and asymptomatic left ventricular ejection fraction (LVEF) decline occurred during the period of trastuzumab administration.3-8,15-19 Unlike cardiac toxic effects associated with anthracyclines, LVEF decline following trastuzumab therapy is not dose related and is considered to be mostly reversible.20 Most previous clinical trials involving trastuzumab included patients who were exposed to anthracyclines, but it is not clear how much the anthracyclines contributed to trastuzumab-mediated cardiac dysfunction. To reduce cardiac and noncardiac toxic effects with the hope of maintaining a high degree of effectiveness, we conducted a trial of weekly paclitaxel with trastuzumab in patients with early-stage ERBB2-positive breast cancer. The overall study results have been previously reported, and this article highlights the detailed cardiac data that have been collected.21

Category: Cardio-Oncology

Date: 2020

Author: Chau Dang, MD; Hao Guo, MS; Julie Najita, PhD; Denise Yardley, MD; Kelly Marcom, MD; Kathy Albain, MD; Hope Rugo, MD; Kathy Miller, MD; Matthew Ellis, MD, PhD; Iuliana Shapira, MD; Antonio C. Wolff, MD; Lisa A. Carey, MD; Beverly Moy, MD; John Groarke, MD; Javid Moslehi, MD; Ian Krop, MD, PhD; Harold J. Burstein, MD, PhD; Clifford Hudis, MD; Eric P. Winer, MD; Sara M. Tolaney, MD

Abstract / Description:

Cardiac resynchronization therapy (CRT) improved heart function in patients who developed chemotherapy-induced cardiomyopathy (CHIC), according to findings from a small study published in JAMA. At a 6-month follow-up, 24 of 26 patients (83%) had either no symptoms or mild symptoms of heart failure after CRT.

Category: Cardio-Oncology

Date: 2020

Author: Rachel Narozniak, MA

Abstract / Description:

There is an increasing awareness and clinical interest in cardiac safety during cancer therapy as well as in optimally addressing cardiac issues in cancer survivors. Although there is an emerging expertise in this area, known as cardio-oncology, there is a lack of organization in the essential components of contemporary training. This proposal, an international consensus statement organized by the International Cardioncology Society and the Canadian Cardiac Oncology Network, attempts to marshal the important ongoing efforts for training the next generation of cardio-oncologists. The necessary elements are outlined, including the expectations for exposure necessary to develop adequate training. There should also be a commitment to local, regional, and international education and research in cardio-oncology as a requirement for advancement in the field.

Category: Cardio-Oncology

Date: 2020

Author: Daniel J. Lenihan, MD,Gregory Hartlage, MD; Jeanne DeCara, MD; Anne Blaes, MD; J. Emanuel Finet, MD; Alexander R. Lyon, MD; Robert F. Cornell, MD; Javid Moslehi, MD; Guilherme H. Oliveira, MD; Gillian Murtagh, MD; Michael Fisch, MD; Gary Zeevi, MD; Zaza Iakobishvili, MD; Ron Witteles, MD; Aarti Patel, MD; Eric Harrison, MD; Michael Fradley, MD; Giuseppe Curigliano, MD; Carrie Geisberg Lenneman, MD; Andreia Magalhaes, MD; Ron Krone, MD; Charles Porter, MD; Susmita Parasher, MD; Susan Dent, MD; Pamela Douglas, MD;Joseph Carver, MD

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Abstract / Description:

The Dallas Heart Study (DHS) was initiated in 2000 with funding from the Donald W. Reynolds Foundation and with the primary goal of improving the diagnosis, prevention, and treatment of heart disease. From 2000 to 2002, 6,000 residents of Dallas County, aged 18 to 65 years, completed a detailed medical survey. Participants over age 30 (n=3,500) were invited to provide a blood sample and to undergo comprehensive state-of-the-art imaging studies to assess plaque buildup in the blood vessels of the heart, the size and function of the heart, and the amount and distribution of body fat.

Category: General CV

Author: N/A

Abstract / Description:

BACKGROUND In patients with type 2 diabetes, inhibitors of sodiumñglucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes. METHODS In this phase 3, placebo-controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. RESULTS Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371 patients (21.2%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P

Category: General CV

Date: 2019

Author: John J.V. McMurray, M.D., Scott D. Solomon, M.D., Silvio E. Inzucchi, M.D., Lars K¯ber, M.D., D.M.Sc., Mikhail N. Kosiborod, M.D., Felipe A. Martinez, M.D., Piotr Ponikowski, M.D., Ph.D., Marc S. Sabatine, M.D., M.P.H., Inder S. Anand, M.D., Jan B?lohl·vek, M.D., Ph.D., Michael Bˆhm, M.D., Ph.D., Chern-En Chiang, M.D., Ph.D., et al., for the DAPA-HF Trial Committees and Investigators*

Abstract / Description:

BACKGROUND In patients with type 2 diabetes, inhibitors of sodiumñglucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes. METHODS In this phase 3, placebo-controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. RESULTS Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371 patients (21.2%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P

Category: General CV

Date: 2019

Author: John J.V. McMurray, M.D., Scott D. Solomon, M.D., Silvio E. Inzucchi, M.D., Lars K¯ber, M.D., D.M.Sc., Mikhail N. Kosiborod, M.D., Felipe A. Martinez, M.D., Piotr Ponikowski, M.D., Ph.D., Marc S. Sabatine, M.D., M.P.H., Inder S. Anand, M.D., Jan B?lohl·vek, M.D., Ph.D., Michael Bˆhm, M.D., Ph.D., Chern-En Chiang, M.D., Ph.D., Vijay K. Chopra, M.D., Rudolf A. de Boer, M.D., Ph.D., Akshay S. Desai, M.D., M.P.H., Mirta Diez, M.D., Jaroslaw Drozdz, M.D., Ph.D., Andrej Duk·t, M.D., Ph.D., Junbo Ge, M.D., Jonathan G. Howlett, M.D., Tzvetana Katova, M.D., Ph.D., Masafumi Kitakaze, M.D., Ph.D., Charlotta E.A. Ljungman, M.D., Ph.D., BÈla Merkely, M.D., Ph.D., Jose C. Nicolau, M.D., Ph.D., Eileen OíMeara, M.D., Mark C. Petrie, M.B., Ch.B., Pham N. Vinh, M.D., Ph.D., Morten Schou, M.D., Ph.D., Sergey Tereshchenko, M.D., Ph.D., Subodh Verma, M.D., Ph.D., Claes Held, M.D., Ph.D., David L. DeMets, Ph.D., Kieran F. Docherty, M.B., Ch.B., Pardeep S. Jhund, M.B., Ch.B., Ph.D., Olof Bengtsson, Ph. Lic., Mikaela Sjˆstrand, M.D., Ph.D., and Anna-Maria Langkilde, M.D., Ph.D. for the DAPA-HF Trial Committees and Investigators*

Abstract / Description:

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure and preventing cardiovascular disease (CVD), but little data exist on these associations in US Hispanics/Latinos. We sought to assess associations between DASH score and prevalence of metabolic syndrome (MetS) and its components in diverse Hispanics/Latinos. We studied 10,741 adults aged 18ñ74 in the multicenter Hispanic Community Health Study/Study of Latinos. Dietary intake was measured using two 24-hour recalls, and MetS defined per the 2009 harmonized guidelines. We assessed cross-sectional associations of DASH score and MetS (and its dichotomized components) using survey logistic regression, and DASH and MetS continuous components using linear regression. We also stratified these models by Hispanic/Latino heritage group to explore heritage-specific associations. We found no associations between DASH and MetS prevalence. DASH was inversely associated with both measures of blood pressure (p?0.01 for systolic and p?0.001 for diastolic) in the overall cohort. DASH was also inversely associated with diastolic blood pressure in the Mexican (p?0.05), Central American (p?0.05), and South American (p?0.01) groups; triglycerides (p?0.05) in the Central American group; fasting glucose overall (p?0.01) and in the Mexican group (p?0.01); and waist circumference overall (p?0.05) and in the South American group (p?0.01). DASH was positively associated with HDL-cholesterol (p?0.01) in the Central American group. DASH may better capture diet-MetS associations in Hispanic/Latino subpopulations such as Central/South Americans; this study also adds evidence that Hispanics/Latinos should be analyzed by heritage. Further research, and/or culturally tailored DASH measures will help further explain between-heritage differences.

Category: Hispanic/Latino

Date: 2020

Author: Brian T. Joycea,?, Donghong Wub, Lifang Houa, Qi Daic, Sheila F. Castanedad, Linda C. Galloe,Gregory A. Talaveraf, Daniela Sotres-Alvarezg, Linda Van Hornh, Jeannette M. Beasleyi,Tasneem Khambatyj, Tali Elfassyk, Donglin Zengl, Josiemer Matteim, Leonor Corsinon,Martha L. Daviglus

Abstract / Description:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing the disease COVID-19, has rapidly transformed our lives. Fears of community spread of the virus have led policy makers to close schools and nonessential businesses and implement orders to shelter in place. While these efforts have slowed the spread of the virus, some parts of the country, including New York City and New Orleans, have nevertheless witnessed overwhelming increases in COVID-19 cases and related deaths. The burden of COVID-19 morbidity and mortality has disproportionately fallen on minority populations. Early in the pandemic, lower rates of COVID-19 testing were reported among minority communities. Now, emerging data illustrate that black and Hispanic Americans are dying at far higher rates from the novel coronavirus than any other groups in the nation.1,2 These disparities are just the most recent manifestation of centuries’ worth of racial and ethnic gaps in health outcomes.3

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Utibe R. Essien, MD, MPH; Atheendar Venkataramani, MD, PhD

Abstract / Description:

Summer is usually accompanied by family barbecues and picnics outside. But those burgers and chips may be wreaking havoc on your blood pressure. 1 in 3 U.S. adults have high blood pressure according to the CDC, and only about half of them have their blood pressure under control.

Category: General CV

Date: 2019

Author: Sophie Heinemann

Abstract / Description:

Transition from fetal to postnatal life is a complex process. Even in the absence of congenital heart disease, about4ñ10% of newborns require some form of assistance in the delivery room. Neonates with complex congenitalheart disease should be expected to require significant intervention and thus the resuscitation team must be wellprepared for such a delivery. Prenatal assessment including fetal and maternal health in general and detailedinformation on fetal heart structure, function and hemodynamics in particular are crucial for planning the de-livery and resuscitation. In addition, understanding the impact of cardiac structural anomaly and associatedaltered bloodflow on early postnatal transition is essential for success of resuscitation in the delivery room. Inthis article, we will briefly review transitional circulation focusing on altered hemodynamics of the complexcongenital heart diseases and then discuss the process of preparing for these high-risk deliveries. Finally, we willreview the pathophysiology resulting from the cardiac structural anomaly with resultant altered fetal circulationand discuss delivery room management of specific critical congenital heart diseases.

Category: Cardio-Obstetrics

Date: 2019

Author: Jay D. Pruetza, Shuo (Sue) Wang, Shahab Noori

Abstract / Description:

Income and poverty measures can indicate the extent to which a community may be able to successfully adhere to COVID-19 mitigation measures (such as “stay at home” and “quarantine family members who are sick”). Lower-income individuals are more likely to be living in crowded households where there are more people than rooms, making quarantining sick family members more difficult. Low-income individuals are more likely to be working in service positions on the front line of COVID-19 including as at-home health aides for seniors, grocery store clerks, and nannies, and may not be able to “stay at home.” Lower-income individuals are more likely to experience health conditions such as high blood pressure and diabetes that may increase the likelihood of hospitalization and death among COVID-19 patients. There are a myriad of reasons why lower-income and poorer communities will be more vulnerable to the COVID-19 virus as explored in additional indicators on this webpage.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: The Data Center

Year: 2020

Abstract / Description:

Could older recommendations of maintaining blood pressure of 140/90 mmHg be misleading for reducing heart disease in young adults with type 1 diabetes? Young adults with type 1 diabetes have an increased risk of mortality related to cardiovascular disease. High blood pressure and high glucose levels pose a threat for young adults with type 1 diabetes developing heart disease. The findings that blood pressure levels greater or equal to 120/80mmHg are associated with high risk of heart disease was presented at the American Diabetes Association (ADAís) 79th Scientific Sessions in San Francisco. The evidence presented was taken from the study, ìOptimal Blood Pressure Goals for Cardiovascular Health in Individuals with Type 1 Diabetes.î

Category: General CV

Date: 2019

Author: David L. Joffe

Abstract / Description:

Dr. Dharmesh Patel talks about how the use of burdensome utilization management practices such as prior authorization keep potentially life-saving therapies from patients.

Category: General CV

Date: 2018

Author: Alliance for Patient Access

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Abstract / Description:

Each Cigarette Brings You Closer to Addiction

Category: Tobacco

Author: FDA Tabacco Education Resources

Abstract / Description:

The coronavirus entered Milwaukee from a white, affluent suburb. Then it took root in the city’s black community and erupted. As public health officials watched cases rise in March, too many in the community shrugged off warnings. Rumors and conspiracy theories proliferated on social media, pushing the bogus idea that black people are somehow immune to the disease. And much of the initial focus was on international travel, so those who knew no one returning from Asia or Europe were quick to dismiss the risk. Then, when the shelter-in-place order came, there was a natural pushback among those who recalled other painful government restrictions — including segregation and mass incarceration — on where black people could walk and gather.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Akilah Johnson and Talia Buford

Year: 2020

Abstract / Description:

This is a summary of three articles in Preventing Chronic Disease 2018 Special Collection1 submitted by states funded by the Centers for Disease Control and Preventionís (CDCís) State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health (DP13-1305) and State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke (DP14-1422) cooperative agreements.1,2

Category: General CV

Date: 2018

Author: Centers for Disease Control and Prevention (CDC)

Abstract / Description:

Background-óAssessing and optimizing cardiovascular health (CVH) early in life, such as in pregnancy, could lead to a longerlifetime spent in better CVH and reduce the risk of cardiovascular disease. This might especially benefit women with a hypertensivedisorder of pregnancy (HDP) who are more likely to develop atherosclerosis and cardiovascular disease. We hypothesized that CVHin pregnancy is related to later life CVH and carotid intima-media thickness (CIMT), and that these associations differ betweenwomen with a normotensive pregnancy and women with an HDP. This study was conducted within the prospective population-based Generation R Study. Conclusions-óAlready in pregnancy, better CVH is associated with a smaller CIMT and better CVH 10 years postpartum, especiallyin women with an HDP. As pregnancy is an incentive for women to improve lifestyle, assessing CVH in pregnancy might help improve postpartum CVH and reduce cardiovascular disease risk

Category: Cardio-Obstetrics

Date: 2019

Author: Laura Benschop, MD, PhD; Sarah Schalekamp-Timmermans, MD, PhD; Sara J. C. Schelling, MD; Eric A. P. Steegers, MD, PhD; Jeanine E. Roeters van Lennep, MD, PhD

Abstract / Description:

Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care?related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double?blind, placebo?controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow?up. We used a single?patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to Ä1, 118 (±2,475), and the median costs were Ä332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO2max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. Conclusions In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system.

Category: Cost of Care

Date: 2020

Author: Djawid Hashemi, Ludwig Dettmann, Tobias D. Trippel, Volker Holzendorf, Johannes Petutschnigg, Rolf Wachter, Gerd Hasenfuß, Burkert Pieske, Antonia Zapf, Frank Edelmann

Abstract / Description:

Context:Cardiovascular disease in the U.S. accounted for healthcare cost and productivity losses of$330 billion in 2013?2014 and diabetes accounted for $327 billion in 2017. The impact is dispro-portionate on minority and low-SES populations. This paper examines the available evidence oncost, economic benefit, and cost effectiveness of interventions that engage community health work-ers to prevent cardiovascular disease, prevent type 2 diabetes, and manage type 2 diabetes.Evidence acquisition:Literature from the inception of databases through July 2016 was searchedfor studies with economic information, yielding nine studies in cardiovascular disease prevention,seven studies in type 2 diabetes prevention, and 13 studies in type 2 diabetes management. Analyseswere done in 2017. Monetary values are reported in 2016 U.S. dollars.Evidence synthesis:The median intervention cost per patient per year was $329 for cardiovasculardisease prevention, $600 for type 2 diabetes prevention, and $571 for type 2 diabetes management.The median change in healthcare cost per patient per year was?$82 for cardiovascular disease pre-vention and?$72 for type 2 diabetes management. For type 2 diabetes prevention, one study saw nochange and another reported?$1,242 for healthcare cost. One study reported a favorable 1.8 returnon investment from engaging community health workers for cardiovascular disease prevention.Median cost per quality-adjusted life year gained was $17,670 for cardiovascular disease prevention,$17,138 (mean) for type 2 diabetes prevention, and $35,837 for type 2 diabetes management.Conclusions:Interventions engaging community health workers are cost effective for cardiovas-cular disease prevention and type 2 diabetes management, based on a conservative $50,000 bench-mark for cost per quality-adjusted life year gained. Two cost per quality-adjusted life year estimatesfor type 2 diabetes prevention were far below the $50,000 benchmark.Am J Prev Med 2019;56(3):e95?e106. Published by Elsevier Inc. on behalf of American Journal of PreventiveMedicine.

Category: General CV

Date: 2019

Author: Verughese Jacob, PhD, MPH,1 Sajal K. Chattopadhyay, PhD,1 David P. Hopkins, MD, MPH,1 Jeffrey A. Reynolds, MPH,1 Ka Zang Xiong, MPH,1 Christopher D. Jones, PhD, MSW,2 Betsy J. Rodriguez, MSN,3 Krista K. Proia, MPH,3 Nicolaas P. Pronk, PhD, MA,4,5 John M. Clymer, BA,6 Ron Z. Goetzel, PhD,7,8 and the Community Preventive Services Task Force (CPSTF)

Abstract / Description:

Question  Does an 18-month intervention incorporating behavioral counseling, care coordination, and care management reduce cardiovascular risk in adults with serious mental illness, a population at extremely high risk of cardiovascular disease morbidity and mortality? Findings  In this randomized clinical trial enrolling 269 participants with serious mental illness and at least 1 cardiovascular risk factor, the intervention group participants had a 12.7% relative reduction in the 10-year probability of a cardiovascular event, compared with the control group. Meaning  These findings support the use of a behavioral counseling, care coordination, and care management intervention to substantially reduce cardiovascular health disparities in this high-risk population.

Category: General CV

Date: 2020

Author: Gail L. Daumit, MD, MHS; Arlene T. Dalcin, MS, RD; Faith B. Dickerson, PhD, MPH; Edgar R. Miller, MD, PhD; A. Eden Evins, MD, MPH; Corinne Cather, PhD; Gerald J. Jerome, PhD; Deborah R. Young, PhD; Jeanne B. Charleston, RN; Joseph V. Gennusa III, PhD, RD, LDN; Stacy Goldsholl, MS; Courtney Cook; Ann Heller, RN; Emma E. McGinty, PhD; Rosa M. Crum, MD, MHS; Lawrence J. Appel, MD, MPH; Nae-Yuh Wang, PhD

Abstract / Description:

Atherosclerotic cardiovascular disease remains a major cause of death and disability, especially for high-risk familial hypercholesterolemia individuals. PCSK9i (proprotein convertase subtilisin kexin type 9 inhibitors) reduce low-density lipoprotein cholesterol levels and cardiovascular event rates. However, PCSK9i prescriptions are rejected at high rates by payers, and use is often delayed or eventually abandoned as a treatment option. We tested the hypothesis that acute coronary syndromes, coronary interventions, stroke, and cardiac arrest are more prevalent in patients with rejected or abandoned PCSK9i prescriptions than for those with paid PCSK9i prescriptions.

Category: General CV

Date: 2019

Author: Kelly D. Myers , Niloofar Farboodi, Mkaya Mwamburi, William Howard, David Staszak, Samuel Gidding, Seth J. Baum, Katherine Wilemon, Daniel J. Rader

Abstract / Description:

Background Lipoprotein(a) concentration is associated with cardiovascular events. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C). Objectives A pre-specified analysis of the placebo-controlled ODYSSEY Outcomes trial in patients with recent acute coronary syndrome (ACS) determined whether alirocumab-induced changes in lipoprotein(a) and LDL-C independently predicted major adverse cardiovascular events (MACE). Methods One to 12 months after ACS, 18,924 patients on high-intensity statin therapy were randomized to alirocumab or placebo and followed for 2.8 years (median). Lipoprotein(a) was measured at randomization and 4 and 12 months thereafter. The primary MACE outcome was coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina. Results Baseline lipoprotein(a) levels (median: 21.2 mg/dl; interquartile range [IQR]: 6.7 to 59.6 mg/dl) and LDL-C [corrected for cholesterol content in lipoprotein(a)] predicted MACE. Alirocumab reduced lipoprotein(a) by 5.0 mg/dl (IQR: 0 to 13.5 mg/dl), corrected LDL-C by 51.1 mg/dl (IQR: 33.7 to 67.2 mg/dl), and reduced the risk of MACE (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.78 to 0.93). Alirocumab-induced reductions of lipoprotein(a) and corrected LDL-C independently predicted lower risk of MACE, after adjustment for baseline concentrations of both lipoproteins and demographic and clinical characteristics. A 1-mg/dl reduction in lipoprotein(a) with alirocumab was associated with a HR of 0.994 (95% CI: 0.990 to 0.999; p = 0.0081). Conclusions Baseline lipoprotein(a) and corrected LDL-C levels and their reductions by alirocumab predicted the risk of MACE after recent ACS. Lipoprotein(a) lowering by alirocumab is an independent contributor to MACE reduction, which suggests that lipoprotein(a) should be an independent treatment target after ACS. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)

Category: General CV

Date: 2020

Author: Vera A. Bittner, Michael Szarek, Philip E. Aylward, Deepak L. Bhatt, Rafael Diaz, Jay M. Edelberg, Zlatko Fras, Shaun G. Goodman, Sigrun Halvorsen, Corinne Hanotin, Robert A. Harrington, J. Wouter Jukema, Virginie Loizeau, Patrick M. Moriarty, AngËle Moryusef, Robert Pordy, Matthew T. Roe, Peter Sinnaeve, Sotirios Tsimikas, Robert Vogel, Harvey D. White, Doron Zahger, Andreas M. Zeiher, Ph. Gabriel Steg, Gregory G. Schwartz and for the ODYSSEY OUTCOMES Committees and Investigators

Abstract / Description:

Question  Can inflammation modulate lipoprotein(a)–associated cardiovascular risk during secondary prevention in optimally treated patients with high-risk vascular disease? Findings  In a prespecified post hoc secondary analysis of the ACCELERATE trial, in patients with established vascular disease who were optimally treated, increasing lipoprotein(a) levels (assessed as either quintiles or continuous logarithmic transformed levels) during treatment were significantly associated with cardiovascular death, myocardial infarction, and stroke only in individuals with high-sensitivity C-reactive protein levels of 2 mg/L or higher during treatment, but not in those with levels less than 2 mg/L. Similar significant associations were identified in time-to-first event rates and survival curves, as well as specifically in the placebo-treated group. Meaning  There is likely to be incremental benefit in lowering lipoprotein(a) levels in optimally treated patients with high-risk vascular disease, which appears to be optimized in patients with concomitant high-sensitivity C-reactive protein levels of 2 mg/L or more.

Category: General CV

Date: 2020

Author: Rishi Puri, MBBS, PhD; Steven E. Nissen, MD; Benoit J. Arsenault, PhD; Julie St John, MS; Jeffrey S. Riesmeyer, MD; Giacomo Ruotolo, MD, PhD; Ellen McErlean, MSN; Venu Menon, MD Leslie Cho, MD1; Kathy Wolski, MPH; A. Michael Lincoff, MD; Stephen J. Nicholls, MBBS, PhD

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Abstract / Description:

Background and Purpose— Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden. Methods— Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. Conclusions— The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.

Category: Stroke

Date: 2020

Author: Daniel T. Lackland, DrPH, FAHA, Chair; Edward J. Roccella, PhD, MPH, Co-Chair; Anne F. Deutsch, RN, PhD, CRRN; Myriam Fornage, PhD, FAHA; Mary G. George, MD, MSPH, FAHA; George Howard, DrPH, FAHA; Brett M. Kissela, MD, MS; Steven J. Kittner, MD, MPH, FAHA; Judith H. Lichtman, PhD, MPH; Lynda D. Lisabeth, PhD, MPH, FAHA; Lee H. Schwamm, MD, FAHA; Eric E. Smith, MD, MPH, FAHA; Amytis Towfighi, MD;

Category: General CV

Author: American Heart Association

Abstract / Description:

Background Data are sparse on the association of cardiovascular health (CVH) in younger/middle age with the incidence of dementia later in life. Methods and Results We linked the CHA (Chicago Heart Association Detection Project in Industry) study data, assessed in 1967 to 1973, with 1991 to 2010 Medicare and National Death Index data. Favorable CVH was defined as untreated systolic blood pressure/diastolic blood pressure ?120/?80 mm Hg, untreated serum total cholesterol

Category: General CV

Date: 2018

Author: Thanh?Huyen T. Vu , Lihui Zhao, Lei Liu, Cuiping Schiman, Donald M. Lloyd?Jones, Martha L. Daviglus, Kiang Liu, Daniel B. Garside, Jeremiah Stamler, James F. Fries, Ya?Chen Tina Shih, and Norrina B. Allen

Abstract / Description:

When Boehringer Ingelheim and Eli Lillyís diabetes med Jardiance first showed CV benefits in trial patients, it changed the game for the SGLT2 inhibitor class. Now, not content to rest on its laurels, Jardiance is going after an indication in chronic heart failureóand the FDA just sped up the process. The FDA Wednesday slapped its Fast Track designation on the drug as a treatment for reducing the risks of cardiovascular death and hospitalization for heart failure among chronic heart failure patients. The agency reserves the designation, which will help facilitate an expedited review and possible future approval, for novel therapies in areas of unmet clinical need, Boehringer said in a release.

Category: General CV

Date: 2019

Author: Kyle Blankenship

Abstract / Description:

Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient education for improving chronic disease management, but none have focused on Latino stroke patients. The Hispanic Secondary Stroke Prevention Initiative is a randomized study of 200 stroke patients designed to evaluate the impact of a 12-month multi-modal Community Health Worker (CHW) and mHealth intervention on blood pressure control. Eligible participants were Latinos who experienced a mild-moderate stroke within the last five years. The CHW component included home visits, telephone calls, and daily text messages to obtain home blood pressure readings and provide patient navigation and health education. Feasibility was defined as the proportion of patients that responded to at least half the messages. Pre-post paired t-tests assessed improvements in question accuracy while correlation coefficients highlighted improvements in response rates. Among the 65 participants randomized to the intervention, the response rate was as follows: 37% - >50% response, 21% - 25-50%, 19% - 10-25%, and 23% - <10%, This finding suggests that mHealth interventions may be challenging in this population. However, the proportion of questions answered correctly increased from 63% to 84% in the intervention periodís last two months (p<0.05). There was a positive correlation between increased response rates and response accuracy to patient education assessments (r=0.82, p<0.05). These improvements in health knowledge suggest that a subset of patients may benefit from mHealth interventions, and the benefit correlates with use.

Category: Hispanic/Latino, Telehealth

Date: 2019

Author: Stuti Dang, Kasra Sarhadi, Sonjia Kenya, Chuanhui Dong, Natalie Ferras, Jose Romano, Olveen Carrasquillo

Abstract / Description:

Worries about healthcare expenses may limit calls to 9-1-1 for suspected strokes on the southside of Chicago. Ambulance charges may limit willingness to call 9-1-1 when people experience stroke symptoms in south Chicago, according to preliminary research presented at the American Stroke Associationís International Stroke Conference 2018, a world premier meeting dedicated to the science and treatment of cerebrovascular disease for researchers and clinicians. Stroke outcomes can vary dramatically among neighborhoods in the city of Chicago, Illinois, researchers said. In this study, researchers analyzed responses from a survey of 364 Chicago residents to assess stroke knowledge, self-efficacy and barriers to calling 9-1-1. Responses were separated into those from the north side (199) and those from the south side (165) of the city. The north-side residents were more educated, while the south-side residents were more interested in participating in stroke education programs and had visited hospitals and doctors less frequently in the recent past. The north-side residents reported feeling more overwhelmed by life in the near recent past. Although both north-side and south-side residents did not feel strongly that they could recognize stroke, the south-side residents felt more confident than the north-side residents. Researchers sampled whites, blacks and Hispanics equally on both sides of the city. While stroke knowledge was similar between neighborhoods, perceptions and attitudes differed by geographic regions in the city.

Category: Stroke

Date: 2018

Author: Soyang Kwon, Ph.D.; Erin Wymore, M.S.; Namratha Kandula, M.D.; Jen Brown, M.S.; Amy Eisenstein, Ph.D.; Christopher Richards, M.D., M.S.; Maryann Mason, Ph.D.; Heather Beckstrom, B.A.; Peggy Jones, B.A.; Knitasha Washington DHA, MHA, FACHE; and Neelum Aggarwal, M.D., M.S.

Abstract / Description:

Introduction Financial hardship is associated with coronary heart disease risk factors, and may disproportionately affect some African American groups. This study examines whether stress because of financial hardship is associated with incident coronary heart disease in African Americans. Methods The Jackson Heart Study is a longitudinal cohort study of cardiovascular disease risks in African Americans in the Jackson, Mississippi metropolitan statistical area. Participant enrollment began in 2000. Analyses were performed in 2017 and included adjudicated endpoints through December 2012. Financial stress was assessed from the Jackson Heart Study Weekly Stress Inventory and categorized into four levels: (1) did not experience financial stress, (2) no stress, (3) mild stress, and (4) moderate to high stress. Incident coronary heart disease was defined as the first event of definite or probable myocardial infarction, definite fatal myocardial infarction, definite fatal coronary heart disease, or cardiac procedure. There were 2,256 individuals in this analysis. Results Participants with moderate to high (versus no) financial stress were more likely to have incident coronary heart disease events after controlling for demographics, SES, access to care, and traditional clinical risk factors (hazard ratio=2.42, 95% CI=1.13, 5.17). The association between financial stress and coronary heart disease was no longer statistically significant in a model adjusting for three specific risk factors: depression, smoking status, and diabetes (hazard ratio=1.99, 95% CI=0.91, 4.39). Conclusions Financial stress may be an unrecognized risk factor for coronary heart disease for African Americans. Additional research should examine these associations in intervention studies that address perceived stress, in addition to other coronary heart disease risk factors, in patients experiencing financial stress.

Category: Black/African American CV

Date: 2019

Author: Kaitlyn E. Moran, MPH Mark J. Ommerborn, MPH Chad T. Blackshear, MS Mario Sims, PhD, MS Cheryl R. Clark, MD, ScD

Abstract / Description:

It is the one field that most people run away from,î says Dr. Tracy Callister of cardiology. ìI am interested in helping people.î Dr. Callister is a Fellow of the American College of Cardiology, an internationally recognized leader in the field of cardiovascular disease and cardiovascular CT, a Diplomat of the American Board of Internal Medicine/Cardiovascular Disease and a member of The American College of Chest Physicians, The American Society of Nuclear Cardiology and The Society for Cardiovascular Angiography and Interventions. Dr. Callister attended David Geffen School of Medicine at UCLA, which preceded a cardiology fellowship at the University of Vermont where he trained in stents.

Category: General CV

Author: Alex Hendrickson

Abstract / Description:

On Saturday, September 7, First Lady Tammy Murphy will host a Family Festival in Atlantic City. As part of Nurture NJ, her statewide awareness campaign to combat the maternal and infant health crisis in New Jersey, the First Lady developed the Family Festival event series to target cities with high rates of maternal and infant mortality and connect mothers, fathers, grandparents, and anyone else involved in taking care of a child with state, county, and local resourcesócreating a one-stop shop for state, county, and local resources.

Category: Cardio-Obstetrics

Date: 2019

Author: Inside New Jersey - Press Release

Abstract / Description:

Background: Food insecurity is a public health problem. There is limited data on food insecurity in Mississippi. Methods: We analyzed data from the 2015 Mississippi Behavioral Risk Factor Surveillance System, which included the Social Context Module for 5870 respondents. Respondents who indicated that in the past 12 months they were ìalwaysî, ìusuallyî, or ìsometimesî ìworried or stressed about having enough money to buy nutritious mealsî were considered food insecure. Food insecurity was compared across sociodemographic and health characteristics using chi-square tests, and the association between food insecurity and select cardiovascular disease risk factors was assessed using logistic regression. Results: The prevalence of food insecurity was 42.9%. Compared to the referent group, Mississippi adults with high blood pressure had 51% higher odds, those with diabetes had 30% higher odds, those who were not physically active had 36% higher odds, and those who consumed fewer than five fruits and vegetables daily had 50% higher odds of being food insecure. Conclusion: Among Mississippi adults, food insecurity is associated with high blood pressure, diabetes, obesity, fruit and vegetable consumption, physical inactivity, and smoking.

Category: Black/African American CV

Date: 2018

Author: Vincent L. Mendy 1,*OrcID,Rodolfo Vargas 2,Gerri Cannon-Smith 2,Marinelle Payton 1,3,Byambaa Enkhmaa 4 andLei Zhang 2

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Abstract / Description:

Disparities in health care do exist, and there are steps women can take to make sure to get the care they need

Category: General CV

Date: 2020

Author: Jennifer Nelson

Abstract / Description:

This reality is common to men and women in the U.S. of all races: they all are more likely to die from heart disease than any other cause (1). Beyond this commonality, however, lie substantial variations in cardiac care according to gender and race. In 2002, a comprehensive review of studies about disparities by the Kaiser Family Foundation and the American College of Cardiology Foundation (2) found significant differences in cardiac care for minority groups. According to these studies, African-American patients, for example, are less likely than white patients to undergo diagnostic tests and revascularization, even after controlling for clinical and socioeconomic factors. The Kaiser findings mirrored a 2002 Institute of Medicine report (3) that concluded that racial/ethnic variations in medical care are widespread.

Category: General CV

Date: 2005

Author: Rita F.RedbergMD, MSc(FACC)

Abstract / Description:

An underdiagnosed genetic mutation in people of African descent carries an increased risk for heart failure, according to a new study. When present in those patients, a genetic variant, TTR V122I, could lead to a higher risk of hereditary transthyretin amyloid cardiomyopathy ó a potentially fatal disease caused by a protein buildup in the heart. Researchers at Mount Sinai School of Medicine and the University of Pennsylvania School of Medicine published the study in the Journal of the American Medical Association. Heart disease is a leading cause of death among all genders and racial and ethnic groups, but non-Hispanic black people are more than twice as likely to die of heart disease, according to the Centers for Disease Control and Prevention. The discovery underscores the need to study nonwhite populations and their health concerns, clinicians say. Heart failure, a condition in which the heart doesnít pump blood well enough to meet the needs of the body, can result from other forms of heart disease, the Mayo Clinic said.

Category: Black/African American CV

Date: 2020

Author: Lateshia Beachum

Abstract / Description:

Advances in human genetics are improving the understanding of a variety of inherited cardiovascular diseases, including cardiomyopathies, arrhythmic disorders, vascular disorders, and lipid disorders such as familial hypercholesterolemia. However, not all cardiovascular practitioners are fully aware of the utility and potential pitfalls of incorporating genetic test results into the care of patients and their families. This statement summarizes current best practices with respect to genetic testing and its implications for the management of inherited cardiovascular diseases.

Category: General CV

Date: 2020

Author: Kiran Musunuru, MD, PhD, MPH, ML, FAHA, Chair; Ray E. Hershberger, MD, FAHA, Vice Chair; Sharlene M. Day, MD; N. Jennifer Klinedinst, PhD, MPH, RN, FAHA; Andrew P. Landstrom, MD, PhD, FAHA; Victoria N. Parikh, MD; Siddharth Prakash, MD, PhD, FAHA; Christopher Semsarian, MBBS, PhD, MPH, FAHA; Amy C. Sturm, MS, LCGC; on behalf of the American Heart Association Council on Genomic and Precision Medicine; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology

Abstract / Description:

Background Left ventricular (LV) hypertrophy affects up to 43% of African Americans (AAs). Antihypertensive treatment reduces LV mass (LVM). However, interindividual variation in LV traits in response to antihypertensive treatments exists. We hypothesized that genetic variants may modify the association of antihypertensive treatment class with LV traits measured by echocardiography. Methods We evaluated the main effects of the three most common antihypertensive treatments for AAs as well as the single nucleotide polymorphism (SNP)?by?drug interaction on LVM and relative wall thickness (RWT) in 2,068 participants across five community?based cohorts. Treatments included thiazide diuretics (TDs), angiotensin converting enzyme inhibitors (ACE?Is), and dihydropyridine calcium channel blockers (dCCBs) and were compared in a pairwise manner. We performed fixed effects inverse variance weighted meta?analyses of main effects of drugs and 2.5 million SNP?by?drug interaction estimates. Results We observed that dCCBs versus TDs were associated with higher LVM after adjusting for covariates (p = 0.001). We report three SNPs at a single locus on chromosome 20 that modified the association between RWT and treatment when comparing dCCBs to ACE?Is with consistent effects across cohorts (smallest p = 4.7 ◊ 10?8, minor allele frequency range 0.09ñ0.12). This locus has been linked to LV hypertrophy in a previous study. A marginally significant locus in BICD1 (rs326641) was validated in an external population. Conclusions Our study identified one locus having genome?wide significant SNP?by?drug interaction effect on RWT among dCCB users in comparison to ACE?I users. Upon additional validation in future studies, our findings can enhance the precision of medical approaches in hypertension treatment.

Category: Black/African American CV

Date: 2019

Author: Anh N. Do Wei Zhao Abigail S. Baldridge Laura M. Raffield Kerri L. Wiggins Sanjiv J. Shah Stella Aslibekyan Hemant K. Tiwari Nita Limdi Degui Zhi Colleen M. Sitlani Kent D. Taylor Bruce M. Psaty Nona Sotoodehnia Jennifer A. Brody Laura J. Rasmussen?Torvik Donald Lloyd?Jones Leslie A. Lange James G. Wilson Jennifer A. Smith Sharon L. R. Kardia Thomas H. Mosley Ramachandran S. Vasan Donna K. Arnett Marguerite R. Irvin

Abstract / Description:

Objectives. Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race. Methods. We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004ñ2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates. Results. Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama. Conclusions. Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.

Category: Black/African American CV

Date: 2014

Author: Will JC1, Nwaise IA1, Schieb L1, Zhong Y1.

Abstract / Description:

Objectives. Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race. Methods. We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004ñ2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates. Results. Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama. Conclusions. Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.

Category: General CV

Date: 2014

Author: Julie C. Will, PhD, Isaac A. Nwaise, MA, PhD, Linda Schieb, MSPH, Yuna Zhong, MSPH

Abstract / Description:

To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease-2019 (COVID-19) cumulative incidence and mortality in the United States.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Vibhu Parcha, MD; Gargya Malla, MD, MPH; Sarabjeet S. Suri, MD; Rajat Kalra, MBChB; Brittain Heindl, MD; Lorenzo Berra, MD; Mona N. Fouad, MD, MPH;Garima Arora, MD;Pankaj Arora, MD

Abstract / Description:

Cardiologist James Beckerman has dedicated his career to heart health and shares the As cardiologist and medical director of the Providence Heart Instituteís Basecamp Cardiac Prevention + Wellness initiative in Portland, Oregon, James Beckerman collaborates with the community to create free programs such as Play Smart Youth Heart Screenings and Heart to Start, a multi-state exercise program. He is the team cardiologist for the Portland Timbers Major League Soccer franchise and is a member of the American College of Cardiologyís Leadership Council on Sports and Exercise, WebMDís Clinical Advisory Board, and the Ironheart Foundationís Board of Directors. James holds degrees from Harvard University and Harvard Medical School and completed his internal medicine and cardiology training at Massachusetts General Hospital and Stanford University. As cardiologist and medical director of the Providence Heart Instituteís Basecamp Cardiac Prevention + Wellness initiative in Portland, Oregon, James Beckerman collaborates with the community to create free programs such as Play Smart Youth Heart Screenings and Heart to Start, a multi-state exercise program. He is the team cardiologist for the Portland Timbers Major League Soccer franchise and is a member of the American College of Cardiologyís Leadership Council on Sports and Exercise, WebMDís Clinical Advisory Board, and the Ironheart Foundationís Board of Directors. James holds degrees from Harvard University and Harvard Medical School and completed his internal medicine and cardiology training at Massachusetts General Hospital and Stanford University As cardiologist and medical director of the Providence Heart Instituteís Basecamp Cardiac Prevention + Wellness initiative in Portland, Oregon, James Beckerman collaborates with the community to create free programs such as Play Smart Youth Heart Screenings and Heart to Start, a multi-state exercise program. He is the team cardiologist for the Portland Timbers Major League Soccer franchise and is a member of the American College of Cardiologyís Leadership Council on Sports and Exercise, WebMDís Clinical Advisory Board, and the Ironheart Foundationís Board of Directors. James holds degrees from Harvard University and Harvard Medical School and completed his internal medicine and cardiology training at Massachusetts General Hospital and Stanford University This talk was given at a TEDx event using the TED conference format but independently organized by a local community.

Category: General CV

Date: 2017

Author: James Beckerman

Abstract / Description:

Most of us have heard that high cholesterol is dangerous to our health but experts say thereís one type of cholesterol that needs to be high. Jessie Hollinger, a physicianís assistant on staff at Lee Memorial Health System, says there are actually two types of cholesterol. ìWe break it down to good cholesterol and bad cholesterol. So when you hear that your cholesterol is bad weíre usually talking about LDL, we want it to be low. And the good cholesterol is the HDL, we want it to be high.î A healthy personís LDL needs to be less than 130, whereas, the HDL needs to be higher than 60. ìThe good cholesterol is really important and we really strive for greater than 60 for that because it helps get rid of the bad cholesterol,î said Hollinger. If a patientís LDL is too high or their HDL is too low theyíre at risk for a stroke or cardiovascular disease. ìI think a lot of us have low HDL because weíre not quite getting the activity we need. But on the flip side Iím also seeing a lot of higher bad cholesterol because weíre eating at fast food restaurants or weíre going out every weekend because itís just so convenient,î said Hollinger. Those with high LDL need to limit red meat and dairy products and increase their exercise. ìGood cholesterol comes from exercise and genetics,î said Hollinger. Patients who have high LDL could also need medication to lower their cholesterol. ìYouíre not feeling that your arteries are clogging up with plaque, which is built from the cholesterol,î said Hollinger. She says itís important to establish annual checkups with your doctor. View More Health Matters video segments at leememorial.org/healthmatters/ Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, weíve been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

Category: General CV

Date: 2016

Author: Lee Health

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Abstract / Description:

Key Components:Expansion of Access to care: Medicaid will cover a full year's postpartum care; Standardize data collection: CDC will be required to collect data from states on official maternal mortality rates. Best Practices: Establishes and enforces National Emergency Obstetric Protocols; Enforce an environment where providers work together to provide appropriate care; Access to Culturally-Competent Care

Category: Cardio-Obstetrics

Date: 2019

Author: Robin Kelly

Abstract / Description:

Background: Inequity in health and healthcare is a critical issue that will not likely be solved without adequate physician knowledge about underserved populations. The ACGME and medical schools have begun to address this by expecting competency in systems-based practice which embraces the greater systems issues that influence health inequities. In our residency programs—and we suspect in many others—there is no baseline knowledge of issues affecting the communities residents serve. Previous studies have emphasized the importance of working with key stakeholders and experts to develop effective curricula and obtain needs assessments. Methods: Through discussion with representatives of our Offices of Cultural Diversity and Community Outreach and Engagement, as well as review of the literature and our health system’s most recent CHNA, we modeled a survey to assess resident knowledge of 4 underserved groups in our community: African Americans, Latinos, LGBTQ, and Orthodox Jews. All incoming residents to our institution in June 2016 attended a panel discussion as part of orientation. Community members representing the 4 underserved groups served on the panel and introduced incoming residents to the needs and issues of the communities that they will serve during their residency. All residents (n = 46) were encouraged to take pre- and post-panel surveys to assess the change in their cultural competency. Thirty-eight surveys were available for analysis. Results: Resident knowledge was greatest (highest pretest scores) in the customs and issues involving African Americans and Latinos and poorest regarding cultural competency pertaining to LGBTQ and Orthodox Jews. There was a significant difference in the pre- and post-panel survey responses (P 

Category: Medical Education

Date: 2018

Author: David Kountz, Kristi Kosarin, Ashleigh Clair, Cecilia Phong, Neel Patel, Laura Frank, Darryl Hughes, Yen Hong Kuo and Asa Dewan

Abstract / Description:

In many Western states, as well as Arkansas which has a large Marshallese population, these communities have virus rates that far exceed their share of the population.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Anita Hofschneider

Abstract / Description:

Approximately 60 million Americans reside in rural areas of the United States. Although this represents only 20% of the US population, rural Americans have a lower life expectancy than their metropolitan counterparts.1,2 The higher rate of premature death can be traced to a higher incidence of heart disease, cancer, unintentional injury, respiratory disease, and stroke. In addition, infant mortality, alcohol and drug abuse, obesity, diabetes, and HIV infection affect a higher percentage of rural Americans compared with urban residents.3,4

Category: Equity

Date: 2020

Author: Theresa Capriotti, DO, MSN, CRNP, RN Tiffany Pearson, BSN Lillian Dufour, BSN

Abstract / Description:

Introduction: The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. Methods: We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. Results: We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. Discussion: HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.

Category: Equity, Medical Education

Date: 2019

Author: Joanna Perdomo, Destiny Tolliver, Heather Hsu, Yuan He, Katherine A. Nash, Stephanie Donatelli, Camila Mateo, Cynthia Akagbosu, Faraz Alizadeh, Alexandra Power-Hays, Tyler Rainer, Daniel J. Zheng, Caroline J. Kistin, Robert J. Vinci, Catherine D. Michelson

Abstract / Description:

Federal, state and local governments are struggling to identify best practices for controlling the spread of COVID-19 while minimizing the negative effects of sweeping public health interventions, especially for poor and marginalized communities, which may be hardest hit. Social distancing and sheltering in place have emerged as a key strategies for flattening the curve of the epidemic and mitigating impacts on already-stressed health care systems. Measures to keep people at least six feet apart as much as possible—by closing schools, limiting the operations of nonessential businesses, and urging or requiring people to work from home and avoid gatherings—mean that many people will be sheltering in place for weeks or months. As authorities implement restrictions on personal liberty in some of the areas hit particularly hard by COVID-19, the potential for discriminatory enforcement and police escalation may endanger the safety and civil rights of at-risk and traditionally marginalized populations.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Emily A. Benfer Lindsay F. Wiley

Abstract / Description:

Covid-19 is hitting black and brown communities especially hard. But many states aren't releasing or collecting the data to help fight back.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: LAURA BARR”N-L”PEZ, HOLLY OTTERBEIN and MAYA KING

Abstract / Description:

Early data shows the coronavirus is hitting black and brown Americans especially hard. But spotty government data collection and publication could prevent resources from flowing to the communities most ravaged by the pandemic.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: LAURA BARRÓN-LÓPEZ, HOLLY OTTERBEIN and MAYA KING

Abstract / Description:

This course on healthcare disparities is designed to increase awareness about racial and ethnic disparities across the spectrum of healthcare services and examine the use of patient-centered communication skills to minimize these disparities. This course includes peer-reviewed research, interactive case studies, and multimedia assessments that address topics including how the patient-physician relationship can contribute to disparities and how unconscious bias may conflict with consciously-held egalitarian values. The full course was evaluated using a randomized-controlled trial with a national sample of 130 physicians and resident physicians. It appears to have global effects on physicians' knowledge of disparities, attitudes toward unconscious bias, and satisfaction with virtual patient encounters.

Category: Equity, Medical Education

Date: 2014

Author: Eileen Van Schaik, PhD, Alex Howson, Janice Sabin

Abstract / Description:

Healthy Start works to reduce infant mortality rates (the rate at which babies die before their first birthday). The†infant mortality rates for African Americans in west Louisville neighborhoods (West of 9th St.) are more than double the†rate of the Louisville Metro area (7.1) as a whole, and more than triple the rate for Caucasians, in Metro Louisville. The goals of the Healthy Start program include helping moms in these zip codes have healthy pregnancies,†deliver healthy and full-term babies.†Important determinants of racial differences in infant mortality are low birth†weight (less than 5.5 pounds) and very low birth weight (less than 3.3 pounds). The Healthy Start initiative in Louisville is one of only a few across†the country that had no infant deaths among participants from 2002†to 2005.

Category: Cardio-Obstetrics

Date: 2019

Author: LouisvilleKY.gov

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Abstract / Description:

Over the last two years, I traveled to 22 cities. I took a deep dive into why healthcare costs so much. With a seasoned journalism professor mentoring me by phone almost every night, I traveled to meet with hospital executives and start-ups companies, doctors and insurance executives, nurses and state legislators, rural hospitals and big pharma, and most importantly, patients. As a fan of the modern-day civil rights leader Bryan Stevenson, I have admired his message that in order to address social issues, we need to be proximate to the problem. So I decided to apply the same approach to understand the business of medicine. I shed my white coat and embarked on a reporting trip across the country.

Category: Cost of Care

Date: 2019

Author: Martin Makary MD, MPH

Abstract / Description:

The goal of CenteringPregnancy is to provide medical care and to educate but also to reduce stress and isolation, which can contribute to poor birth outcomes. Years of studies ó many focusing on teen and low-income moms ó have found that babies born to women in CenteringPregnancy groups are less likely to be premature, be underweight or spend time in the intensive care unit.

Category: Cardio-Obstetrics

Date: 2019

Author: Jenny Gold

Abstract / Description:

Cardiovascular disease (CVD) remains the leading cause of death in women in the United States and globally, with heart disease actually on the rise among middle-aged women in the United States. This disease burden can be reduced by prioritizing a preventive approach to cardiovascular health. The 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of CVD contains important updates for delivery of primary prevention and also highlights early menopause and pre-eclampsia as two female-specific risk factors that enhance CVD risk. Additionally other female-specific risk factors including early menarche, polycystic ovarian syndrome, multi-parity, other adverse pregnancy outcomes, and hormone therapy also influence women’s CVD risk throughout their lifespan. It is vital that both women and healthcare clinicians are made aware of this information as it has lifesaving potential. This review aims to (1) Introduce the key points of the 2019 ACC/AHA Guideline (2) Highlight the evidence for the female-specific risk factors for refining CVD risk assessment and (3) Discuss the impact of the female-specific risk enhancing factors on primary prevention interventions such as statin therapy. This approach will be able to more personalize risk assessment in women, with an emphasis on the importance of shared decision making in building authentic partnerships between clinicians and women patients throughout their lifespan

Category: General CV

Date: 2020

Author: Petal Eldera, Garima Sharma. Martha Gulati, Erin D.Michos

Abstract / Description:

In the United States, causes of racial differences in stroke and its risk factors remain only partly understood, and there is a long-standing disparity in stroke incidence and mortality impacting Black Americans. Only half of the excess risk of stroke in the United States Black population is explained by traditional risk factors, suggesting potential effects of other factors including genetic and biological characteristics. Here, we nonsystematically reviewed candidate laboratory biomarkers for stroke and their relationships to racial disparities in stroke. Current evidence indicates that IL-6 (interleukin-6), a proinflammatory cytokine, mediates racial disparities in stroke through its association with traditional risk factors. Only one reviewed biomarker, Lp(a) (lipoprotein[a]), is a race-specific risk factor for stroke. Lp(a) is highly genetically determined and levels are substantially higher in Black than White people; clinical and pharmaceutical ramifications for stroke prevention remain uncertain. Other studied stroke risk biomarkers did not explain racial differences in stroke. More research on Lp(a) and other biological and genetic risk factors is needed to understand and mitigate racial disparities in stroke.

Category: Black/African American CV, Stroke

Date: 2020

Author: Debora Kamin Mukaz, Neil A. Zakai, Salvador Cruz-Flores, Louise D. McCullough, Mary Cushman

Abstract / Description:

BACKGROUND: Children from socially disadvantaged families experience worse hospital outcomes compared with other children. We sought to identify modifiable barriers to care to target for intervention. METHODS: We conducted a prospective cohort study of hospitalized children over 15 months. Caregivers completed a survey within 3 days of admission and 2 to 8 weeks after discharge to assess 10 reported barriers to care related to their interactions within the health care system (eg, not feeling like they have sufficient skills to navigate the system and experiencing marginalization). Associations between barriers and outcomes (30-day readmissions and length of stay) were assessed by using multivariable regression. Barriers associated with worse outcomes were then tested for associations with a cumulative social disadvantage score based on 5 family sociodemographic characteristics (eg, low income). RESULTS: Of eligible families, 61% (n = 3651) completed the admission survey; of those, 48% (n = 1734) completed follow-up. Nine of 10 barriers were associated with at least 1 worse hospital outcome. Of those, 4 were also positively associated with cumulative social disadvantage: perceiving the system as a barrier (adjusted ? = 1.66; 95% confidence interval [CI] 1.02 to 2.30), skill barriers (? = 3.82; 95% CI 3.22 to 4.43), cultural distance (? = 1.75; 95% CI 1.36 to 2.15), and marginalization (? = .71; 95% CI 0.30 to 1.11). Low income had the most consistently strong association with reported barriers. CONCLUSIONS: System barriers, skill barriers, cultural distance, and marginalization were significantly associated with both worse hospital outcomes and social disadvantage, suggesting these are promising targets for intervention to decrease disparities for hospitalized children.

Category: Equity

Date: 2020

Author: K. Casey Lion, Chuan Zhou, Beth E. Ebel, Robert B. Penfold and Rita Mangione-Smith

Abstract / Description:

ennifer Prah Ruger, the director of the Health Equity and Policy Lab at the University of Pennsylvania, studies national and international public-health policies through a moral lens, examining the ways in which world leaders can insure more just health outcomes for their fellow-citizens, as well as for citizens of other nations—and how those two things necessarily intersect. Prah Ruger’s work is influenced by her former teacher Amartya Sen, whose “capabilities approach” to economics—developed with the philosopher Martha Nussbaum—envisions a broad definition of human flourishing, one that transcends indicators like G.D.P. Prah Ruger’s most recent book, “Global Health Justice and Governance,” published in 2018, examines international crisis responses to past epidemics, such as the Ebola outbreak of 2014. “Public health and health care systems capacity and governance vary considerably across the globe,” Prah Ruger writes. “Like rapidly spreading contagions and global inequalities, this arbitrary patchwork of health systems is morally troubling.” That work is especially relevant today, with the coronavirus pandemic straining health systems around the world, from China to Italy and the United States. In the U.S.—a country that is infamous for the unequal outcomes of its health system—hospitals find themselves overwhelmed with patients and short on medical equipment.

Category: Equity

Date: 2020

Author: Isaac Chotiner

Abstract / Description:

Background Uncontrolled hypertension contributes to disparities in cardiovascular outcomes. Patient intervention strategies informed by behavioral economics and social psychology could improve blood pressure (BP) control in disadvantaged minority populations. Objective To assess the impact on BP control of an intervention combining short-term financial incentives with promotion of intrinsic motivation among highly disadvantaged patients. Design Randomized controlled trial. Participants Two hundred seven adults (98% African American or Latino) aged 18 or older with uncontrolled hypertension attending Federally Qualified Health Centers.

Category: Black/African American CV

Date: 2019

Author: Martin F. Shapiro MD, CM, PhD, Suzanne B. Shu PhD, Noah J. Goldstein PhD, Ronald G. Victor MD, Craig R. Fox PhD, Chi-Hong Tseng PhD, Sitaram Vangala MA, Braden K. Mogler MD, Stewart B. Reed MD, Estivali Villa BA & JosÈ J. Escarce MD, PhD

Abstract / Description:

BACKGROUND: Uncontrolled hypertension contributes to disparities in cardiovascular outcomes. Patient intervention strategies informed by behavioral economics and social psychology could improve blood pressure (BP) control in disadvantaged minority populations. OBJECTIVE: To assess the impact on BP control of an intervention combining short-term financial incentives with promotion of intrinsic motivation among highly disadvantaged patients. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred seven adults (98% African American or Latino) aged 18 or older with uncontrolled hypertension attending Federally Qualified Health Centers. INTERVENTION: Six-month intervention, combining financial incentives for measuring home BP, recording medication use, BP improvement, and achieving target BP values with counseling linking hypertension control efforts to participants' personal reasons to stay healthy. MAIN MEASURES: Primary outcomes: percentage achieving systolic BP (SBP)

Category: Cost of Care

Date: 2019

Author: Martin F. Shapiro MD, CM, PhD, Suzanne B. Shu PhD, Noah J. Goldstein PhD, Ronald G. Victor MD, Craig R. Fox PhD, Chi-Hong Tseng PhD, Sitaram Vangala MA, Braden K. Mogler MD, Stewart B. Reed MD, Estivali Villa BA & José J. Escarce MD, PhD

Abstract / Description:

Objective Abdominal obesity and wall thickness of the central arteries have been associated with higher risk of cardiovascular disease. Despite the higher burden of overweight and cardiovascular disease among African Americans, limited data are available on the association of abdominal obesity with aortic wall thickness in African Americans. We assessed the cross?sectional and the longitudinal associations of abdominal obesity with aortic intima?media thickness (aIMT) in a cohort of African Americans from the Jackson Heart Study. Methods Data on aIMT and repeated measures of waist circumference (WC) and waist to height ratio from 1,572 participants, as well as on abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and aIMT from 1,223 participants, were analyzed. aIMT was measured at proximal ascending aorta (PA?aIMT), proximal descending aorta (PD?aIMT), and distal aorta (bifurcation) using cardiac magnetic resonance. SAT and VAT were measured using computerized tomography. Results WC and WHtR were longitudinally associated with PA?aIMT and PD?aIMT; SAT and VAT were associated with PA?aIMT only. Only WC was associated with distal aIMT. Conclusions Abdominal obesity measures are associated with increased proximal aIMT in adult African Americans. Only WC is associated with wall thickness in all three segments of the aorta.

Category: Black/African American CV

Date: 2019

Author: Fawaz Mzayek Lisa E. Wang George Relyea Xinhua Yu James G. Terry Jeffrey Carr Gregory W. Hundley Michael E. Hall Adolfo Correa

Abstract / Description:

Background Cancer treatment can lead to left ventricular (LV) dysfunction in female cancer survivors of reproductive age, and pregnancy-related hemodynamic stress may result in LV dysfunction or heart failure (HF). Objectives The authors performed a systematic review and meta-analysis to determine the incidence of LV systolic dysfunction or HF during or soon after pregnancy in cancer survivors and evaluated the impact of history of cancer therapeutics-related cardiac dysfunction (CTRCD). Methods We systematically searched electronic databases (MEDLINE and EMBASE) from inception to January 2020 to identify cohort studies that examined cardiac disease in pregnant cancer survivors. Meta-analysis was performed using the inverse-variance fixed effects method. Potential sources of heterogeneity were explored using subgroup analyses and meta-regression. Results Of 13,782 identified articles, 6 studies consisting of 2,016 pregnancies, predominantly in childhood cancer survivors, were included. Overall, there were 33 cardiac events. The total weighted incidence of LV dysfunction or HF with pregnancy was 1.7% (95% confidence interval [CI]: 0.9% to 2.7%) overall; 28.4% (95% CI: 14.6% to 43.9%) in those with a history of CTRCD and 0.24% (95% CI: 0% to 0.81%) in those without, translating into an odds ratio of 47.4 (95% CI: 17.9 to 125.8). Interstudy heterogeneity was low (I2 = 17.5%). Metaregression did not reveal significant sources of heterogeneity. Conclusions The incidence of LV dysfunction or HF during pregnancy in cancer survivors was low. Although risk estimates are limited by the small number of events, women with a history of CTRCD compared to those without had a 47.4-fold higher odds of experiencing pregnancy-related LV dysfunction or HF.

Category: Cardio-Obstetrics, Cardio-Oncology

Date: 2020

Author: Mark Nolan, Evangelos K. Oikonomou, Candice K. Silversides, Melissa R. Hines, Kara A. Thompson, Belinda A. Campbell, Eitan Amir, Cynthia Maxwell and Paaladinesh Thavendiranathan

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Abstract / Description:

Too few Medicare recipients take part in cardiac rehabilitation despite the services being available to them, according to new research that showed women, the elderly and minorities are most likely to miss out.

Category: General CV

Date: 2020

Author: American Heart Association News

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Abstract / Description:

Dr. Ferdinand discusses ending disparities in cardiovascular care and barriers that keep patients from the treatment they need.

Category: General CV

Date: 2019

Author: Alliance for Patient Access

Abstract / Description:

The Rana family learns that cholesterol can be genetic as their son get it at a young age after his father's near-fatal heart attack; KDKA's Gilma Avalos.

Category: Asian/Pacific Islander CV

Date: 2019

Author: Cleveland CBS

Abstract / Description:

Know the warning signs of stroke so you can act FAST

Category: Black/African American CV

Date: 2012

Author: Ascension Via Christi

Abstract / Description:

Founders interview about genetically high lipoprotein(a) and the associated 60% plus increased risk for cardiovascular disease

Category: General CV

Date: 2019

Author: Lipoprotein a foundation

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Abstract / Description:

As the U.S. Government continues to push back against the economic downturn and the spread of COVID-19, disadvantaged groups—such as Latinos—aren’t receiving an equitable share. The recently passed $484 billion stimulus package will give millions of Americans and U.S. businesses with economic relief, in combination with past relief legislation. However, the money isn’t reaching workers who need it the most, like Latino immigrants.

Category: COVID-19 Impact on Minority Health, Hispanic/Latino

Date: 2020

Author: Josh McCormack

Abstract / Description:

In March 2020, when there were 30,000 confirmed Covid-19 cases in the United States, one of us wrote about the pandemic’s effects on undocumented immigrants.1 By August, there were about 50,000 new U.S. cases per day, and we had spent several months caring for patients with Covid-19. Today, revisiting the issues of anti-immigrant policies, limited access to care, language barriers, and the need to work elicits painful memories of the people we’ve met in the hospital and the community.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Kathleen R. Page, M.D., and Alejandra Flores-Miller

Category: Cardio-Oncology

Date: 2016

Author: Sherry-Ann Brown, MD, PhD1Nicole Sandhu, MD, PhD

Abstract / Description:

In this report we examine the level of knowledge about heart attack symptoms and what action to take if a heart attack is suspected among Native Hawaiian and Pacific Islander (NHPI) adults in the United States using data from the 2014 NHPI-National Health Interview Survey. Analyses include summary statistics to describe levels of heart attack knowledge and multivariate logistic regression to identify characteristics associated with having the recommended heart attack knowledge. Less than half (44.4%) of NHPI adults have the recommended heart attack knowledge. Significant differences in knowledge levels were found based on age; those aged 45ñ64 years and those aged 65 years and older were 68% and 78% more likely, respectively, to have the recommended heart attack knowledge compared those aged younger than 45 years. The level of recommended heart attack knowledge among NHPI is lower than that of the general population. Improving the heart attack knowledge of all Americans should continue to be a national priority, but efforts to target this group for heart attack knowledge improvement should be made given their high risk for heart attack.

Category: Asian/Pacific Islander CV

Date: 2020

Author: Holly Felix, PhD, Marie-Rachelle Narcisse, PhD, Brett Rowland, MA, Christopher R Long, PhD, Zoran Bursac, PhD, and Pearl A McElfish, PhDcorresponding author

Abstract / Description:

Heart disease and diseases related to obesity are the leading causes of death in the United States. Members of the lesbian, gay, bisexual, transgender, and intersex (LGBTQ) community tend to have higher rates of obesity and heart disease than the general population.

Category: General CV

Author: Vanderbilt University

Abstract / Description:

Daily habits and actions powerfully affect the risk of cardiovascular disease (CVD), in general, and coronary heart disease, in particular. Regular physical activity, sound nutrition, weight management, and not smoking cigarettes have all been demonstrated to significantly reduce the risk of CVD. In 2 large cohort studies a reduction of risk of CVD of >80% and diabetes >90% were demonstrated in individuals who followed a cluster of these lifestyle practices. The study of the impact of lifestyle factors on CVD risk has coalesced under the framework of ìlifestyle medicine.î Despite the overwhelming evidence that lifestyle factors affect CVD, a distinct minority of individuals are following these practices. The American Heart Association estimates that only 5% of individuals follow all of these lifestyle factors as components of a strategy to achieve ìidealî cardiovascular health. The challenge to the medical and health care communities is to more aggressively incorporate this information into the daily practices of medicine.

Category: General CV

Date: 2018

Author: James M. Rippe

Abstract / Description:

Background: Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW. Materials and Methods: An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates. Results: A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension. Conclusions: Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.

Category: General CV

Date: 2019

Author: Billy A. Caceres, Cindy B. Veldhuis, Kathleen T. Hickey, and Tonda L. Hughes

Abstract / Description:

Four weeks ago, Latinos comprised 14 percent of Chicago’s coronavirus cases and 9 percent of the deaths. Now, it’s 37 percent of the cases and 25 percent of the deaths — in a city where 29 percent of the population is Hispanic.

Category: COVID-19 Impact on Minority Health, Hispanic/Latino

Date: 2020

Author: Fran Spielman and Tina Sfondeles

Abstract / Description:

Background Elevated lipoprotein(a) (Lp[a]) and family history (FHx) of coronary heart disease (CHD) are individually associated with cardiovascular risk, and Lp(a) is commonly measured in those with FHx. Objectives The aim of this study was to determine independent and joint associations of Lp(a) and FHx with atherosclerotic cardiovascular disease (ASCVD) and CHD among asymptomatic subjects. Methods Plasma Lp(a) was measured and FHx was ascertained in 2 cohorts. Elevated Lp(a) was defined as the highest race-specific quintile. Independent and joint associations of Lp(a) and FHx with cardiovascular risk were determined using Cox regression models adjusted for cardiovascular risk factors. Results Among 12,149 ARIC (Atherosclerosis Risk In Communities) participants (54 years, 56% women, 23% black, 44% with FHx), 3,114 ASCVD events were observed during 21 years of follow-up. FHx and elevated Lp(a) were independently associated with ASCVD (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.09 to 1.26, and HR: 1.25; 95% CI: 1.12 to 1.40, respectively), and no Lp(a)-by-FHx interaction was noted (p = 0.75). Compared with subjects without FHx and nonelevated Lp(a), those with either elevated Lp(a) or FHx were at a higher ASCVD risk, while those with both had the highest risk (HR: 1.43; 95% CI: 1.27 to 1.62). Similar findings were observed for CHD risk in ARIC, in analyses stratified by premature FHx, and in an independent cohort, the DHS (Dallas Heart Study). Presence of both elevated Lp(a) and FHx resulted in greater improvement in ASCVD and CHD risk reclassification and discrimination indexes than either marker alone. Conclusions Elevated plasma Lp(a) and FHx have independent and additive joint associations with cardiovascular risk and may be useful concurrently for guiding primary prevention therapy decisions.

Category: General CV

Date: 2020

Author: Anurag Mehta, Salim S. Virani, Colby R. Ayers, Wensheng Sun, Ron C. Hoogeveen, Anand Rohatgi, Jarett D. Berry, Parag H. Joshi, Christie M. Ballantyne and Amit Khera

Abstract / Description:

BACKGROUND Lipoprotein(a) levels are genetically determined and, when elevated, are a risk factor for cardiovascular disease and aortic stenosis. There are no approved pharmacologic therapies to lower lipoprotein(a) levels. METHODS We conducted a randomized, double-blind, placebo-controlled, dose-ranging trial involving 286 patients with established cardiovascular disease and screening lipoprotein(a) levels of at least 60 mg per deciliter (150 nmol per liter). Patients received the hepatocyte-directed antisense oligonucleotide AKCEA-APO(a)-LRx, referred to here as APO(a)-LRx (20, 40, or 60 mg every 4 weeks; 20 mg every 2 weeks; or 20 mg every week), or saline placebo subcutaneously for 6 to 12 months. The lipoprotein(a) level was measured with an isoform-independent assay. The primary end point was the percent change in lipoprotein(a) level from baseline to month 6 of exposure (week 25 in the groups that received monthly doses and week 27 in the groups that received more frequent doses). RESULTS The median baseline lipoprotein(a) levels in the six groups ranged from 204.5 to 246.6 nmol per liter. Administration of APO(a)-LRx resulted in dose-dependent decreases in lipoprotein(a) levels, with mean percent decreases of 35% at a dose of 20 mg every 4 weeks, 56% at 40 mg every 4 weeks, 58% at 20 mg every 2 weeks, 72% at 60 mg every 4 weeks, and 80% at 20 mg every week, as compared with 6% with placebo (P values for the comparison with placebo ranged from 0.003 to

Category: General CV

Date: 2020

Author: Sotirios Tsimikas, M.D., Ewa Karwatowska-Prokopczuk, M.D., Ph.D., Ioanna Gouni-Berthold, M.D., Jean-Claude Tardif, M.D., Seth J. Baum, M.D., Elizabeth Steinhagen-Thiessen, M.D., Michael D. Shapiro, D.O., Erik S. Stroes, M.D., Patrick M. Moriarty, M.D., B¯rge G. Nordestgaard, M.D., D.M.Sc., Shuting Xia, M.S., Jonathan Guerriero, M.B.A., Nicholas J. Viney, B.Sc., Louis OíDea, M.B., B.Ch., B.A.O., and Joseph L. Witztum, M.D. for the AKCEA-APO(a)-LRx Study Investigators*

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Abstract / Description:

Much of cardiovascular outcomes researchóincluding the work published in this journalóaddresses healthcare disparities.1ñ3 As researchers, we frequently describe disparities and, rarely, even suggest and test strategies to reduce them. But, beyond scientific publications, what is the role of the physician and researcher as social advocate and citizen to reduce disparities? That important topic is one we rarely address. Yet it has been increasingly on our minds as Editors given the growing and complex challenges we now see to the health of our patients, which range from accessing affordable care to healthy home environments to climate change.

Category: General CV

Date: 2017

Author: Paul S. Chan, MD, MSc; John A. Spertus, MD, MPH; Brahmajee K. Nallamothu, MD, MPH

Abstract / Description:

Racism, and not race, is a social determinant of health, as leadership from the Ohio State University Wexner Medical Center and Health Sciences Colleges recently declared. Acknowledging this is a foundation for structural and systemic change. Indeed, academic medical centers and health care organizations not acting to eliminate racism are perpetuating its proliferation. Within and outside our walls, we must build a culture of health that empowers populations that have historically been made vulnerable and uproots the manifestations of racism that appear in health care.

Category: Medical Education

Date: 2020

Author: J. Nwando Olayiwola Joshua J. Joseph Autumn R. Glover Harold L. Paz Darrell M. Gray, II

Abstract / Description:

IntroductionDiabetes affects 29 million --one in eleven-- people in the U.S. and at least doubles their risk of heart failure, heart attack, stroke, or other cardiovascular complications. Less than half of them, however, are aware that they are at a much higher risk for cardiovascular disease complications. Lack of awareness prevents people with diabetes, their families, and their health care providers from addressing risks and improving health. Preventable deaths are tragic evidence of the missed opportunities to improve the overall health of people living with diabetes. A national awareness effort is an important public statement of the problem and commitment to addressing it.Connecting Diabetes and Cardiovascular DiseaseDiabetes, particularly type 2 diabetes, and cardiovascular diseases are present in the United States at epidemic proportions. Diabetes affects 29.1 million people in the U.S., including 8.1 million people who are undiagnosed.1 Another 86 million more -- one in three adults -- have prediabetes and 15-30 percent will develop diabetes within five years without change.2 The CDC estimates that currently one in three people in the U.S. will develop diabetes in their lifetime.3

Category: Diabetes and CV

Date: 2017

Abstract / Description:

With the recognition from recent cardiovascular outcome trials that two classes of glucose-lowering agents for type 2 diabetes (T2D), the sodium-glucose linked transporter inhibitors (SGLT2i) and the glucagon-like peptide-1 receptor agonists (GLP-1RA) are associated with cardiovascular (CV) outcome benefit, there has been increasing effort to sort out the implications for clinical practice. A number of major professional organizations and societies involved in the care of diabetes and of CVD have produced recommendations to address these outcomes. Differences result from the burgeoning clinical trial reports of CV outcomes and the fact that the mode of action of the various treatments of T2D are largely not known, leading to differences in interpretation and consequent evolution of treatment recommendations. As would be expected, the documents show various degrees of overlap in the clinical trials cited and more so in the conclusions. The present analysis should be seen as a review of these practice recommendations, selectively integrating and highlighting areas of agreement, specific suggestions, and the differences between the organizations.

Category: Diabetes and CV

Date: 2020

Author: Zachary Bloomgarden, Yehuda Handelsman

Abstract / Description:

Hypertension is a global public health issue and a major cause of morbidity and mortality. Its prevalence is increasing in many Asian countries, with a number of countries with blood pressure above the global average. Although the average systolic blood pressure is decreasing worldwide since the 1980s at the rate of about 1 mm Hg systolic blood pressure per decade, it is increasing in low-income and middle-income countries, especially in the East and South Asian population. Of note, the much larger base Asian population results in a considerably larger absolute number of individuals affected. When compared with Western countries, hypertension among Asian populations has unique features in terms of its onset, clustering of associated cardiovascular risk factors, complications and outcomes. Moreover, only a minority of hypertensive individuals are receiving treatment and achieving control. Projected number of deaths related to hypertension dramatically increased in the last 25 years in some Asian regions with a disproportionately high mortality and morbidity from stroke compared with Western countries. The relation between blood pressure and the risk of stroke is stronger in Asia than in Western regions. Although new Guidelines for hypertension diagnosis and management have been recently released from Europe and North America, the unique features of Asian hypertensive patients raise concerns on the clinical applicability of Western Guidelines to Asian populations. To this purpose, we critically reviewed key elements from the most updated Guidelines. We also discussed their core concepts to verify the impact on hypertension prevention and management in Asian countries.

Category: Asian/Pacific Islander CV

Date: 2019

Author: Fabio Angeli, Gianpaolo Reboldi, Monica Trapasso, Adolfo Aita, Paolo Verdecchia

Abstract / Description:

It was a variation on what has become a grim demographic theme, and not just in California. Infections among Latinos have far outpaced the rest of the nation, a testament to the makeup of the nation’s essential work force as the American epidemic has surged yet again in the last couple of weeks. Latinos in the United States are hardly a cultural monolith, and there is no evidence that any ethnic group is inherently more vulnerable to the virus than others are. But in the last two weeks, counties across the country where at least a quarter of the population is Latino have recorded an increase of 32 percent in new cases, compared to a 15 percent increase for all other counties, a Times analysis shows.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Shawn Hubler, Thomas Fuller, Anjali Singhvi and Juliette Love

Abstract / Description:

According to the CDC, approximately 26 million Americans smoke tobacco daily. In comparison, 14.6 million smoke marijuana every day. In the headlong green rush for dollars -- it's, after all, a $7 billion market in the U.S. -- no one has been able to answer the question of whether all that pot smoking has any ill effects.

Category: General CV

Date: 2020

Author: Chuck Dinerstein, MD, MBA

Abstract / Description:

Aims: Cardiovascular (CV) complications are the leading cause of maternal morbidity and mortality. The objective was to estimate trends in incidence of peripartum CV complications in the United States between 2010-2016. Methods and Results: This was a retrospective analyses using data from the Healthcare Cost and Utilization Project. We included women with delivery codes consistent with delivery, weighted to a national estimate. The primary outcome was the age-adjusted incidence of CV complications among all deliveries, including complications that occurred during re-hospitalizations. Complications were identified using International Classification of Diseases (ICD) codes. Joinpoint regression was used to evaluate time trends and complications were stratified by type. The secondary outcome was in-hospital maternal death among women with a CV complication. Conclusion: Our analyses suggest the rate of peripartum CV complications are increasing in the United States, which highlights the need for active efforts in research and prevention.

Category: Cardio-Obstetrics

Date: 2019

Author: Noopur Goyal, MD; Jennifer S. Herrick, MS; Shannon Son, MD; Torri D. Metz, MD, MS; Rashmee U. Shah, MD, MS

Abstract / Description:

Commonly used in vitro fertilization protocols produce pregnancies without a corpus luteum (CL), a major source of reproductive hormones. In vitro fertilization pregnancies without a CL showed deficient gestational increases of central (aortic) arterial compliance during the first trimester and were at increased risk for developing preeclampsia. Here, we investigated whether there was generalized impairment of cardiovascular adaptation in in vitro fertilization pregnancies without a CL compared with pregnancies conceived spontaneously or through ovarian stimulation, which lead to 1 and >1 CL, respectively. Prototypical maternal cardiovascular adaptations of gestation were serially evaluated noninvasively, initially during the follicular phase before conception, 6◊ in pregnancy, and then, on average, 1.6 years post-partum. The results provided strong support for a critical role of CL factor(s) in the transformation of the maternal cardiovascular system in early gestation. Regimens that lead to the development of a CL or replacement of missing CL factor(s) may be indicated to improve cardiovascular function and reduce preeclampsia risk in in vitro fertilization pregnancies.

Category: Cardio-Obstetrics

Date: 2019

Author: Kirk P. Conrad, John W. Petersen, Yueh-Yun Chi, Xiaoman Zhai, Minjie Li, Kuei-Hsun Chiu, Jing Liu, Melissa D. Lingis, R. Stan Williams, Alice Rhoton-Vlasak, Joseph J. Larocca, Wilmer W. Nichols, Mark S. Segal

Abstract / Description:

Objectives: To describe maternal heart rate patterns observed during antenatal monitoring under resting conditions between the gestational ages of 34 to 38 weeks and to demonstrate its associations with uterine activity. Results: Several distinct maternal heart rate patterns were observed. These included unusually high or low levels of variability, tachycardia, bradycardia, regular and irregular periodic changes and sporadic changes where the heart rate suddenly decreased or increased. Some of the fluctuations, especially decelerations of maternal heart rate, seemed to be associated with uterine activity. Conclusion: The clinical implications of these different patterns, for both the mother and fetus, needs to be explored further. There is a need for computerized analyses of the different maternal patterns during different gestational ages to determine its relevance.

Category: Cardio-Obstetrics

Date: 2018

Author: Hein Odendaal, Coen Groenewald, Michael M Myers, and William P Fifer

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Abstract / Description:

Backgroundó We asked whether visits to physician offices and hospital outpatient clinics for angina have changed over time and whether more frequent use of certain diagnostic techniques or referrals in this setting may account for such changes. Methods and Resultsó We combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to study visits to physician offices and outpatient departments. We calculated both crude and standardized rates for these visits using a modified version of technical specifications published by the Agency for Healthcare Research and Quality. In 1995 to 1998, there were on average 3.6 million office/clinic visits each year for angina among adults in the United States. By 2007 to 2010, this had declined to 2.3 million visits each year. Angina visit rates per 100 000 declined significantly (P

Category: General CV

Date: 2014

Author: Julie C. Will, PhD, MPH; Fleetwood Loustalot, PhD, FNP; Yuling Hong, MD, MSc, PhD, FAHA

Abstract / Description:

The National Indian Health Board is leading a national effort to advocate and secure resources for Tribes to respond to COVID-19. NIHB seeks to ensure that the Tribes remain informed on COVID 19, have the resources and assistance needed to respond to the pandemic, and that the Congress and Administration understand and address Tribal needs and priorities. NIHB also aims to create resources that will be informative and helpful to Tribes and Tribal members. NIHB believes that this coordinated national response is part of its sacred mission to serve the Tribes and help maintain the safety and well-being of Tribal citizens.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: National Indian Health Board

Abstract / Description:

National Minority Cardiovascular Alliance Steering Committee member, Latha Palaniappan, MD, MS, FAHA, FACC, FACP, from Stanford University School of Medicine, knows first hand that health disparities encompass more than statistics, they affect lives, families, and communities. From early on, Dr. Palaniappan knew she wanted to make a difference in the health of Asian/Pacific Islander groups. She has found that the ability to deliver personalized, precision health care is dependent on data, and that specific data is lacking for minority groups. In fact, current data doesn't adequately reflect the extent to which minority populations are affected by cardiovascular disease. To learn more, about our work, visit http://makewellknown.org/nmc-alliance/ Special thank you to the India Community Center for their support of this video

Category: Asian/Pacific Islander CV

Date: 2018

Author: Make Well Known Foundation

Abstract / Description:

According to National Minority Cardiovascular (NMC) Alliance past co-chair, Keith C. Ferdinand, MD, FACC, FAHA, of Tulane University School of Medicine, the lessons that we learned from Hurricane Katrina -- including the fact that people who don't have means often die -- are also true for cardiovascular disease. The storm of cardiovascular medicine still looms large in the United States, with blacks experiencing 21% more deaths from heart disease than whites. The disparity gap is expected to increase without thoughtful collaboration among stakeholders and more equal access to care and treatment. The National Minority Cardiovascular (NMC) Alliance is hosting its second annual Town Hall Event. This yearís topic is centered around our recently refined mission: Minority Cardiovascular Health: Addressing the Influence of Genetics, Culture, and the Social Determinants of Health. Who should attend? Healthcare providers, researchers, professors, students, non-profit professionals, patient advocates, policy advocates, policymakers, patients, members of the media. Anyone who is working on, or interested in learning more about minority cardiovascular health.

Category: Black/African American CV

Date: 2018

Author: The Make Well Known Foundation

Abstract / Description:

An attitudinal survey of more than 350 heart disease patients, providers, caregivers and stakeholders revealed widespread concerns about how health plans delay access to life-saving medication. The issue affects a broad swath of the country. One-third of Americans have high LDL cholesterol, putting them at increased risk for heart disease, the leading cause of death in the United States.1 Meanwhile, one American has a heart attack every 40 seconds.2 For these people, unreasonable medication delays caused by prior authorization or step therapy can be serious, even life threatening. The survey, conducted online from August to September 2018, also found that, while patients may not fully understand the impact of cardiovascular disease risks or treatment options, nearly all respondents agreed that physicians, not health insurers, should

Category: General CV

Date: 2020

Author: PARTNERSHIP TO ADVANCECardiovascular Health

Abstract / Description:

Background The prevalence of angina from 1971 to 1994 was relatively flat for whites and blacks. We ask whether the prevalence and medical history of angina have changed during 1988 to 2012. Methods and Results We used the National Health and Nutrition Examination Survey data from 1988 to 2004 and the data from the six 2-year surveys from 2001 to 2012. We calculated trends in both crude and standardized prevalence rates for the Rose questionnaire on angina (symptomatology) and a question asking whether the respondent had ever been told by a medical professional that they had angina (medical history). In 2009 to 2012, there were on average 3.4 million (95% confidence interval, 2.8ñ4.0 million) people aged ?40 years in the United States each year with angina (Rose questionnaire) and 4.5 million (95% confidence interval, 3.5ñ5.1 million) people with a medical history of angina. The burden of angina varied across age, race, and sex categories, and the pattern of variation differed by whether symptomatology or medical history was assessed. Statistically significant declines in the rates for both outcomes were noted, for the most part, in people aged ?65 years. Age and sex standardized rates declined significantly for whites but not for blacks. Conclusions Rates of angina symptoms and medical history of angina have declined among non-Hispanic whites and among adults aged ?65 years. Blacks have not experienced these same declines. Clearly, additional study is required to understand these declines and to track the future cost and burden of angina in the US population.

Category: Black/African American CV

Date: 2015

Author: Julie C. Will, PhD, MPH, Keming Yuan, MS, and Earl Ford, MD

Abstract / Description:

The SARS-CoV-2 virus is novel, but pandemic threats to indigenous peoples are anything but new. Diseases like measles, smallpox and the Spanish flu have decimated Native American communities ever since the arrival of the first European colonizers. Now COVID-19 is having similarly devastating impacts in Indian country. Some reservations are reporting infection rates many times higher than those observed in the general U.S. population.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Lindsey Schneider, Joshua Sbicca, and Stephanie Malin

Abstract / Description:

The SARS-CoV-2 virus is novel, but pandemic threats to indigenous peoples are anything but new. Diseases like measles, smallpox and the Spanish flu have decimated Native American communities ever since the arrival of the first European colonizers. Now COVID-19 is having similarly devastating impacts in Indian country. Some reservations are reporting infection rates many times higher than those observed in the general U.S. population. We are social scientists who study many aspects of environmental justice, including the politics of food access and food sovereignty, the impacts of extractive resource industries like uranium and fossil fuels, and how Indigenous communities navigate relationships with state and federal governments to maintain their traditional practices. As we see it, Native American communities face structural and historical obstacles related to settler colonial legacies that make it hard for them to counter the pandemic, even by drawing on innovative indigenous survival strategies.

Category: COVID-19 Impact on Minority Health, Native American/American Indian CV

Date: 2020

Author: Lindsey Schneider, Joshua Sbicca, and Stephanie Malin

Abstract / Description:

As Hoopa’s fire chief and its pandemic team leader, Moon feared the impact of the blaze on the dense coniferous forests of the reservation, near Redwood National and State Parks, where 3,000 tribal members depend on steelhead trout and coho salmon fishing. He was even more terrified of a deadly viral outbreak in his tribe, which closed its land to visitors in March.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Miranda Green

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Abstract / Description:

Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.

Category: Occupational Factors and CVD

Date: 2010

Author: Herbert R1, Schechter C, Smith DA, Phillips R, Diamond J, Carroll S, Weiner J, Dahms TE, Landrigan PJ.

Abstract / Description:

Background Our objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults. Methods and Results Employed participants were included (n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest‐held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self‐reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (−3.1%; standard error [SE], 1.0 [P=0.002]). When the analysis was restricted to exposure at the longest‐held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6 [P<0.0001]), decreased LV ejection fraction (−2.7%; SE, 0.6 [P<0.0001]), worse LV global longitudinal strain (1.0%; SE, 0.3 [P=0.0009]), and decreased right ventricular fractional area change (−0.02; SE, 0.004 [P<0.001]). Exposure to pesticides was associated with worse average global longitudinal strain (0.8%; SE, 0.2 [P<0.0001]). Exposure to metals was associated with worse global longitudinal strain in the 2‐chamber view (1.0%; SE, 0.5 [P=0.04]), increased stroke volume (3.6 mL; SE, 1.6 [P=0.03]), and increased LV mass indexed to BSA (9.2 g/m2; SE, 3.8 [P=0.01]) or height (4.4 g/m2.7; SE, 1.9 [P=0.02]). Conclusions Occupational exposures to burning wood, vehicle exhaust, pesticides, and metals were associated with abnormal parameters of LV and right ventricular systolic function. Reducing exposures to toxic chemicals and particulates in the workplace is a potential opportunity to prevent cardiovascular disease in populations at risk.

Category: Hispanic/Latino, Occupational Factors and CVD

Date: 2020

Author: Melissa S. Burroughs Peña, Jean Claude Uwamungu, Catherine M. Bulka, Katrina Swett, Krista M. Perreira, Mayank M. Kansal, Matthew Shane Loop, Barry E. Hurwitz, Martha Daviglus, and Carlos J. Rodriguez

Abstract / Description:

Objectives Cardiovascular disease and osteoporosis are common in HIV?infected patients and residual systemic inflammation is thought to contribute to both of these disorders. We performed a randomized placebo?controlled trial of omega?3?acid (O3A) ethyl esters in HIV?infected patients with hypertriglyceridaemia, hypothesizing that O3A would decrease serum levels of triglycerides, markers of systemic inflammation, and markers of bone turnover. Methods HIV?infected patients (n?=?48 recruited at three sites) with CD4 count >200?cells/?L, suppressed viral load, and triglycerides >200?mg/dL were randomized to placebo or 3.6?g/d of O3A. Fasting lipid profiles and markers of inflammation and bone turnover were assessed at baseline and after 8 weeks of treatment. Results Baseline HIV status, lipid profile, bone metabolism and cardiovascular risk factors were similar between the groups. Inflammatory markers were similar between the treatment groups at baseline, except for interleukin (IL)?6 and tumour necrosis factor (TNF)??, which were higher in the O3A group. The concentration of triglycerides in patients receiving O3A decreased by a median (interquartile range (IQR)) of ?34 (?149, 9.5) mg/dL vs. a median increase of 46.5 (?51, 123) mg/dL in the placebo group (P?=?0.01). The median percentage change in IL?6 was greater in the O3A group compared with the placebo group [?39% (?63, 12%) vs. 29% (10, 177%), respectively; P?=?0.006]. Similar results were observed for TNF??, but not other inflammatory or bone turnover markers. Conclusions O3A ethyl esters decreased the concentrations of triglycerides, IL?6 and TNF?? in patients with well?controlled HIV infection and hypertriglyceridaemia. Larger studies are required to confirm these findings and investigate their clinical significance.

Category: General CV

Date: 2013

Author: TS Metkus J Timpone D Leaf M Bidwell Goetz WS Harris TT Brown

Abstract / Description:

As a graduate student, Ira Memaj began exploring the health disparities that impact many Black Americans. The Detroit grown researcher’s first project was geared to investigating chemo-resistance in ovarian cancer cells leading her to produce over 16 publications in gynecological oncology including ovarian cancer, adhesions, and fibroids. This then inspired to her work at Wayne State University School of Medicine where she was part of a team that patented an antibody, CD11b, as a possible therapeutic agent for ovarian cancer.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Brittany Chambers

Abstract / Description:

Background/objectives: Excess gestational weight gain (GWG) is a risk factor for maternal postpartum weight retention and excessive neonatal adiposity, especially in women with overweight or obesity. Whether lifestyle interventions to reduce excess GWG also reduce 12-month maternal postpartum weight retention and infant weight-for-length†z†score is unknown. Randomized controlled trials from the LIFE-Moms consortium investigated lifestyle interventions that began in pregnancy and tested whether there was benefit through 12 months on maternal postpartum weight retention. Subjects/methods: In LIFE-Moms, women (N?=?1150; 14.1 weeks gestation at enrollment) with overweight or obesity were randomized within each of seven trials to lifestyle intervention or standard care. Conclusion: Compared with standard care, lifestyle interventions initiated in pregnancy and focused on healthy eating, increased physical activity, and other behavioral strategies resulted in significantly less weight retention but similar infant anthropometric outcomes at 12 months postpartum in a large, diverse US population of women with overweight and obesity.

Category: Cardio-Obstetrics

Date: 2019

Author: Suzanne Phelan; Rebecca G. Clifton; Debra Haire-Joshu; Leanne M. Redman; Linda Van Horn; Mary Evans; Kaumudi Joshipura; Kimberly A. Couch; S. Sonia Arteaga; Alison G. Cahill; Kimberly L. Drews; Paul W. Franks; Dympna Gallagher; Jami L. Josefson; Samuel Klein; William C. Knowler; Corby K. Martin; Alan M. Peaceman; Elizabeth A. Thom; Rena R. Wing; Susan Z. Yanovski; Xavier Pi-Sunyer; The LIFE-Moms Research Group

Abstract / Description:

Eliminating heart health disparities amongst African American women

Category: Black/African American CV

Abstract / Description:

Little research has examined associations of positive psychosocial factors with the American Heart Association Life's Simple 7ô (LS7) among African Americans. This study examined the associations between positive optimistic orientation and LS7 among African Americans. Using exam 1 data (2000ñ2004) from the Jackson Heart Study, we examined cross-sectional associations of optimism (in tertiles) with LS7 components [smoking, physical activity, diet, body mass index, blood pressure, cholesterol, glucose] and a composite LS7 score (classified as poor, intermediate, ideal) among 4734 African Americans free of cardiovascular disease. Multivariable prevalence regression was used to estimate prevalence ratios (PR, 95% confidence interval-CI) of intermediate and ideal (vs. poor) individual LS7 components and composite LS7 score by optimism levels, adjusting for demographics, socioeconomic status, and depressive symptoms. For LS7 components with low prevalence, we estimated odds ratios. A greater percentage of participants with high vs. low optimism were younger, female, high SES, and not depressed. After full covariate adjustment, the prevalence ratio of ideal (vs. poor) composite LS7 score was 1.24 for participants who reported high (vs. low) optimism (95% CI 1.09ñ1.42) at exam 1. Higher levels of optimism were also associated with greater prevalence of ideal (vs. poor) physical activity and smoking. Promoting positive optimistic orientation may be an important step toward increasing the likelihood of achieving optimal cardiovascular health among African Americans.

Category: Black/African American CV

Date: 2019

Author: Author links open overlay panelMarioSimsaL·Shaunt· M.GloverabArnita F.NorwoodaChristinaJordanaYuan-IMinaLaPrincess C.BrewercLaura D.Kubzanskyd

Abstract / Description:

Abstract Oral infections and cardiovascular diseases share common biological and behavioral risk factors. Psychosocial determinants could act as a link between general health behavior and dental health behavior. Our objective was to study optimism and life satisfaction as determinants of general and dental health behavior and to evaluate whether these are connected with cardiovascular risk factors and dental diseases. The 1966 Northern Finland Birth Cohort (N = 12,058) is a general population birth cohort. In a postal questionnaire, respondents (N = 8690) were asked about their health behavior and dental status. Cardiovascular risk factors were assessed in health examinations (N = 6033). Generalized linear regression models were used in analysis. The results showed that health orientation increases with strengthening life satisfaction and optimism. Dental health behavior and general health behavior were associated with both cardiovascular risk factors and self-reported dental diseases, which support the assumption that they share a common behavioral background. Keywords cardiovascular risk factors, optimism, life satisfaction, young adults, cohort study

Category: Oral Health

Date: 2003

Author: Ylˆstalo, P. V., Ek, E., Laitinen, J., & Knuuttila, M. L

Abstract / Description:

Main objective The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health. Method A needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis. Results Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants. Relevance to clinical practice The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia.

Category: Oral Health

Date: 2017

Author: Paula Sanchez, Bronwyn Everett, Yenna Salamonson, Shilpi Ajwani, Sameer Bhole, Joshua Bishop, Karen Lintern, Samantha Nolan, Rohan Rajaratnam. Julie Redfern, Maria Sheehan, Fiona Skarligos, Lissa Spencer, Ravi Srinivas, Ajesh George

Abstract / Description:

Abstract During the last two decades, there has been an increasing interest in the impact of oral health on atherosclerosis and subsequent cardiovascular disease (CVD). The advent of the inflammation paradigm in coronary pathogenesis stimulated research in chronic infections caused by a variety of micro-organismsósuch as Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirusóas well as dental pathogens, since these chronic infections are thought to be involved in the etiopathogenesis of CVD by releasing cytokines and other pro-inflammatory mediators (e.g., C-reactive protein [CRP], tumor necrosis factor [TNF-?]) that may initiate a cascade of biochemical reactions and cause endothelial damage and facilitate cholesterol plaque attachment. Yet, due to the multi-factorial nature of dental infection and CVD, confirming a causal association is difficult, and the published results are conflicting. The main deficit in the majority of these studies has been the inadequate control of numerous confounding factors, leading to an overestimation and the imprecise measurement of the predictor or overadjustment of the confounding variables, resulting in underestimation of the risks. A meta-analysis of prospective and retrospective follow-up studies has shown that periodontal disease may increase the risk of CVD by approximately 20% (95% confidence interval [CI], 1.08ñ1.32). Similarly, the reported risk ratio between periodontal disease and stroke is even stronger, varying from 2.85 (CI 1.78ñ4.56) to 1.74 (CI 1.08ñ2.81). The association between peripheral vascular disease and oral health parameters has been explored in only two studies, and the resultant relative risks among individuals with periodontitis were 1.41 (CI 1.12ñ1.77) and 2.27 (CI 1.32ñ3.90), respectively. Overall, it appears that periodontal disease may indeed contribute to the pathogenesis of cardiovascular disease, although the statistical effect size is small. Keywords Oral health, periodontitis, atherosclerosis, coronary heart disease, stroke, peripheral vascular disease

Category: Oral Health

Date: 2004

Author: Jukka H. Meurman, Mariano Sanz, Sok-Ja Janket

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Abstract / Description:

Objective To identify the health beliefs, attitudes, practices and social and family relations important in heart failure treatment among Pacific Islanders. Methods Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. Results Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physiciansí care, poor physician-patient relations, finances, dietary changes, and competing demands on time. Conclusion The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions are affected by an array of psychosocial and socio-cultural factors. Practice Implications Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system.

Category: Asian/Pacific Islander CV

Date: 2008

Author: Joseph Keawe‘aimokuKaholokulaa, Erin Saitoa, Marjorie K.Maua, Renee Latimera, Todd B.Setob

Abstract / Description:

I lay in bed, exhausted after a long day of seeing patients, helping convert our federally qualified health center to telemedicine, and trying to make sense of seemingly conflicting information communicated by the CDC and other government agencies. It was early April, and the frightening preliminary numbers illustrating the disproportionate effect of COVID-19 on black and brown communities(www.lohud.com) weighed heavily on my heart. As a family physician serving an ethnically diverse community in a predominantly white state, I worried about how this virus would affect my patients in the coming weeks and months, and whether their experiences would be documented equitably.

Category: COVID-19 Impact on Minority Health, Equity

Date: 2020

Author: Marie-Elizabeth Ramas, M.D

Abstract / Description:

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases.

Category: Telehealth

Date: 2011

Author: Sanjeev Arora, Summers Kalishman, Denise Dion, Dara Som, Karla Thornton, Arthur Bankhurst, Jeanne Boyle, Michelle Harkins, Kathleen Moseley, Glen Murata, Miriam Komaramy, Joanna Katzman, Kathleen Colleran, Paulina Deming, and Sean Yutzy

Abstract / Description:

Importance Volume metrics may have relevance in the evaluation of valve center expertise. However, a paucity of data exists regarding the quantity, volume, and geographic location of mitral valve (MV) surgical centers in the United States and the proportion of underserved populations they treat. Objectives To evaluate the hospital, patient, and procedural characteristics of mitral valve repair or replacement (MVRR) in the United States as a function of hospital procedure volume. Design, Setting, and Participants This cross-sectional, multicenter observational study was conducted from July 2014 to June 2018. Patients in the Society of Thoracic Surgeons Adult Cardiac Surgery Database undergoing any surgical procedure involving MVRR in the United States were included. Main Outcomes and Measures Volume distribution of MVRR by hospital and hospital referral region. Results There were 165?405 MVRRs performed in 1082 centers during the study period, of which 86?488 (52.3%) were MV repairs. There were 575 centers (53.1%) that performed 25 or more MVRRs per year. The geographic distribution of centers performing 25 or more MVRRs per year differed from those performing fewer than 25 MVRRs per year. Of 304 designated hospital referral regions, 235 (77.3%) had at least 1 center performing 25 or more MVRRs per year, representing accessibility to 1 or more such centers for 296.4 million of 320.1 million US residents (92.6% of the US population; Midwest, 60.0 million of 68.0 million [88.4%]; South, 112.6 million of 122.6 million [91.9%]; West, 68.6 million of 72.9 million [94.1%]; and Northeast, 54.9 million of 56.6 million [97.1%]). Of 304 hospital referral regions, 168 (55.3%) had at least 1 center performing 40 or more MVRRs per year, representing accessibility to 1 or more such centers for 259.8 million of 317.90 million (81.7%) of the US population (Midwest, 50.5 million of 67.9 million [74.5%]; South, 94.5 million of 121.1 million [78.1%]; West, 64.0 million of 72.8 million [88.0%]; Northeast, 50.1 million of 56.3 million [90.2%]). More black and Hispanic patients received operations in centers performing 25 or more MVRRs per year (22?984) vs those performing fewer than 25 MVRRs per year (3227), yet the proportion was higher in lower-volume centers (22?984 of 148?385 [15.5%] vs 3227 of 17?020 [19.0%]; P?.001). In centers performing 25 or more MVRRs per year vs fewer than 25 MVRRs per year, there was a lower percentage of Medicare and Medicaid patients (47?920 of 148?385 [32.3%] vs 6183 of 17?020 [.3%]; P?.001) and patients from rural zip codes (21?208 of 148?385 [14.3%] vs 3146 of 17?020 [18.5%]; P?.001). Conclusions and Relevance Fifty-three percent of all centers performed 25 or more MVRRs per year, and 92.6% of the US population lived in an hospital referral region with at least 1 such center. Disparities in race/ethnicity, rurality, and insurance status exist among patients being treated at centers with different volumes. These data indicate that efforts to centralize care based on volume metrics will need to balance access vs quality.

Category: General CV

Date: 2019

Author: Sreekanth Vemulapalli, MD1,2; Maria Grau-Sepulveda, MD, MPH2; Robert Habib, PhD3; Vinod Thourani, MD4; Joseph Bavaria, MD5; Vinay Badhwar, MD6

Abstract / Description:

Objective Anthracyclines are potent antineoplastic agents in the treatment of lymphoid malignancies, but their therapeutic benefit is limited by cardiotoxicity. The American Heart Association (AHA) recommends routine surveillance, early diagnosis and treatment of anthracycline-based chemotherapy (AC) induced cardiomyopathy (AC-CMP). We aimed to assess the prevalence of AC-CMP in patients with lymphoma, surveillance patterns of left ventricular ejection fraction (LVEF) in those receiving AC and management of patients with AC-CMP at an academic medical centre prior to the development of a comprehensive cardio-oncology programme. Methods We performed a retrospective cohort study examining 218 patients with aggressive B cell non-Hodgkin's lymphomas (B-NHL) who received AC 1992ñ2012 and had serial follow-up. AC-CMP was defined as LVEF decrease ?10% with final LVEF?50% or LVEF reduction ?15% regardless of final LVEF. Results Of 218 patients treated with AC, 73 (34%) had LVEF assessment both prior to and after receiving AC. Of these 73 patients, 24 developed AC-CMP and had higher cumulative all-cause mortality than those without AC-CMP (HR 2.35, p=0.03). Coronary artery disease (CAD) was an independent predictor of AC-CMP (p=0.048). Mean post-AC LVEF was lower in patients with CAD compared with those without CAD when their baseline LVEF was 45% (p=0.0009) or 55% (p=0.001) but was similar at 65% (p=0.33). Less than half of patients with AC-CMP received recommended heart failure medication therapy. Conclusions Historically, one-third of patients with B-NHL treated with AC underwent surveillance according to AHA guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of patients with lymphoma receiving AC.

Category: Cardio-Oncology

Date: 2020

Author: Olivia Y Hung, Jennifer R Brown, Tian Dai, Kirk A Easley, Christopher R Flowers, and Susmita Parashar

Abstract / Description:

Extra weight may affect the heart's normal operation, but DR. ANAND CHOCKALINGAM, MU Health Care, says that shedding those unwanted pounds by simply dieting isn't the answer.

Category: General CV

Date: 2018

Author: Radio Friends with Paul Pepper

Abstract / Description:

t's known as a 'silent killer'. So what, if any, are the warning signs? DR. ANAND CHOCKALINGAM says "the trouble with blood pressure is, unless we take the effort to measure it, we may not recognize that we have high blood pressure."

Category: General CV

Date: 2019

Author: Radio Friends with Paul Pepper

Abstract / Description:

PCSK9 inhibitor class data for commercial claims in the 2018 calendar year. Option to filter by gender and whether a patient has suffered a heart attack or stroke in the 12 months prior to being prescribed a PCSK9 inhibitor through December 2018.

Category: General CV

Date: 2020

Author: Advance Cardio Health

Abstract / Description:

People living with HIV face a higher risk of developing diseases of the heart and blood vessels compared to people without the disease. Seventy-five percent of people living with HIV are over age 45 and face significant health challenges at earlier ages than people who donít have HIV.

Category: General CV

Date: 2019

Author: American Heart Association

Abstract / Description:

OBJECTIVES: To examine African American patient perceptions of racial discrimination in clinical encounters. General barriers to hypertension management were also investigated. METHODS: Six focus groups with 37 African American hypertensive patients were conducted and the transcribed sessions were analyzed for content. RESULTS: Patients valued providers who shared information regarding self-care behaviors to manage hypertension and those who provided information regarding treatment options. Provider assumptions about patient inability to afford services, and provider apathy in reaching diagnoses were perceived as racially discriminatory. Patients discussed providers' avoidance of touch during physical exams as overtly discriminatory. Patients reacted to discriminatory experiences by not keeping appointments with providers perceived as racially discriminatory. Barriers to hypertension management were associated with family responsibilities and lifestyle factors, but were not attributed to provider racial biases. CONCLUSION: Perceiving racial discrimination in clinical encounters may be an important barrier to appointment attendance for African American hypertensive patients.

Category: Black/African American CV

Date: 2010

Author: Greer TM1.

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Abstract / Description:

* Participants were classified as having diagnosed diabetes based on the question ìOther than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?î Participants were classified as having undiagnosed diabetes if they did not report a diagnosis of diabetes by a health care provider, and their fasting (8ñ24 hours) plasma glucose was ?126 mg/dL or their hemoglobin A1C was ?6.5%. Total diabetes was the combined prevalence of diagnosed and undiagnosed diabetes. Ü Current criteria from the American Diabetes Association were applied to define diabetes for all current and previous years of data. Backward calibration equations were used to adjust for changes in laboratory techniques and procedures over time. All estimates for adults are age-adjusted by the direct method to the projected 2000 U.S. Census population using age groups 20ñ39, 40ñ59, and ?60 years. Top From 1999ñ2000 to 2015ñ2016, the prevalence of total diabetes increased from 9.0% to 12.9%. The prevalence of diagnosed diabetes increased from 6.2% to 10.0%. The prevalence of undiagnosed diabetes was 2.8% in 1999ñ2000 and 2.9% in 2015ñ2016 with no significant change over this period.

Category: Diabetes and CV

Date: 2018

R

Abstract / Description:

Rates of high blood pressure, diabetes, and heart disease vary among people of different backgrounds.

Category: General CV

Date: 2015

Author: N/A

Abstract / Description:

Objectives The purpose of this study was to examine race- and sex-based variation in the associations between modifiable risk factors and incident heart failure (HF) among the SCCS (Southern Community Cohort Study) participants. Background Low-income individuals in the southeastern United States have high HF incidence rates, but relative contributions of risk factors to HF are understudied in this population. Methods We studied 27,078 black or white SCCS participants (mean age: 56 years, 69% black, 63% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services. The presence of hypertension, diabetes mellitus, physical underactivity, high body mass index, smoking, high cholesterol, and poor diet was assessed at enrollment. Incident HF was ascertained using International Classification of Diseases-9th revision, codes 428.x in Centers for Medicare and Medicaid Services data through December 31, 2010. Individual risk and population attributable risk for HF for each risk factor were quantified using multivariable Cox models. Results During a median (25th, 75th percentile) 5.2 (3.1, 6.7) years, 4,341 (16%) participants developed HF. Hypertension and diabetes were associated with greatest HF risk, whereas hypertension contributed the greatest population attributable risk, 31.8% (95% confidence interval: 27.3 to 36.0). In black participants, only hypertension and diabetes associated with HF risk; in white participants, smoking and high body mass index also associated with HF risk. Physical underactivity was a risk factor only in white women. Conclusions In this high-risk, low-income cohort, contributions of risk factors to HF varied, particularly by race. To reduce the population burden of HF, interventions tailored for specific race and sex groups may be warranted.

Category: Clinical trials

Date: 2020

Author: Danielle M.Kubicki, BS; Meng Xu, MS; Elvis A.Akwo, MD, PhD; Debra Dixon,MD, MS; Daniel Muñoz,MD; William J.Blot, PhD; Thomas J.Wang, MD; Loren Lipworth, ScD; Deepak K.Gupta, MD, MSCI

Abstract / Description:

PURPOSE: Racial differences in socioeconomic status (SES) explain some, but not all, of racial disparities in cardiovascular disease (CVD) risk. To address this, race disparities among higher SES individuals need to be assessed. The purpose of this study was to assess whether racial disparities in CVD risk factors differ by SES levels. METHODS: Data from the National Health and Nutritional Examination Survey 2007-2014 were used to calculate racial differences in hypertension, high cholesterol, diabetes, and obesity. Interactions between race and SES were assessed. RESULTS: African Americans had higher odds of hypertension (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.72-2.09), diabetes (OR, 1.66; 95% CI, 1.33-2.07), and obesity (OR, 1.64; 95% CI, 1.46-1.83) than whites. Significant interactions between race and income greater than or equal to $100,000 were observed for obesity (OR, 1.55; 95% CI, 1.24-1.94) and between race and education (college graduate or more; OR, 1.58; 95% CI, 1.16-2.15). Disparities in diabetes were observed in the highest SES groups, but not among those in the lowest SES groups. CONCLUSIONS: Race disparities in some CVD risk factors varied by SES levels. Results suggest that race disparities in obesity are larger among those with income greater than or equal to $100,000 and who are college graduates. It is possible that African Americans experience fewer health-related benefits of increased income and education levels compared with whites.

Category: Black/African American CV

Date: 2017

Author: Bell CN1, Thorpe RJ Jr2, Bowie JV2, LaVeist TA3.

Abstract / Description:

Compared to white girls, sexual maturation is accelerated in African American girls as measured by indicators of pubertal development, including age at first menses. Increasing epidemiological evidence suggests that the timing of pubertal development may have strong implications for cardio-metabolic health in adolescence and adulthood. In fact, younger menarcheal age has been related prospectively to poorer cardiovascular risk factor profiles, a worsening of these profiles over time, and an increase in risk for cardiovascular events, including non-fatal incident cardiovascular disease and cardiovascular-specific and all-cause mortality. Yet, because this literature has been limited almost exclusively to white girls/women, whether this same association is present among African American girls/women has not been clarified. In the current narrative review, the well-established vulnerability of African American girls to experience earlier pubertal onset is discussed as are findings from literatures examining the health outcomes of earlier pubertal timing and its antecedents, including early life adversity exposures often experienced disproportionately in African American girls. Gaps in these literatures are highlighted especially with respect to the paucity of research among minority girls/women, and a conceptual framework is posited suggesting disparities in pubertal timing between African American and white girls may partially contribute to well-established disparities in adulthood risk for cardio-metabolic disease between African American and white women. Future research in these areas may point to novel areas for intervention in preventing or lessening the heightened cardio-metabolic risk among African American women, an important public health objective.

Category: Black/African American CV

Date: 2017

Author: Maria E. Bleil, PhD,a Cathryn Booth-LaForce, PhD,a and Aprile D. Benner, PhDb

Abstract / Description:

Background Lifestyle behaviors influence atherosclerotic cardiovascular disease (ASCVD) risk. We examined race and sex differences in the association of ASCVD risk with obesity and lifestyle behaviors. Methods and Results We used multivariable logistic regression to examine the association of race/ethnicity and sex with obesity and lifestyle behaviors among 12 351 adults in the National Health and Nutrition Examination Surveys cycles 2005 to 2014. Ten?year ASCVD risk was estimated using the 2013 American College of Cardiology/American Heart Association pooled cohort equations. Among overweight/obese subjects, whites were more likely to consider themselves overweight, to report a desire to weigh less, and to report a healthy diet, and physical activity. Despite higher body mass index and/or ASCVD risk, black women (adj odds ratio [OR] 0.8, 95% confidence interval [CI], 0.7ñ0.9) were less likely to attempt weight loss, and Hispanic women (OR 0.8, 95% CI 0.6ñ0.9) were less likely to report physical activity than white women. Black women (adj OR 0.6, 95% CI 0.5ñ0.7) were less likely than white women, and Hispanics (women adj OR 0. 6, 95% CI 0.5ñ0.7; men adj OR 0.7, 95% CI 0.6ñ0.9) were less likely than whites to report a healthy diet. Among those with ASCVD risk >7.5%, there were even greater disparities in the likelihood of healthy diet between black and Hispanic versus white women, and among Hispanic versus white men. Conclusions Race/ethnic minorities are less likely to engage in healthy lifestyle behaviors despite higher body mass index and ASCVD risk. These findings underscore the need for culturally sensitive recommendations to improve cardiovascular outcomes in high?risk populations, particularly minority women.

Category: General CV

Date: 2018

Author: Alanna A. Morris , Yi?An Ko, Sarah H. Hutcheson, and Arshed Quyyumi

Abstract / Description:

Backgroundó Prior studies suggest differences in stroke care associated with race/ethnicity. We sought to determine whether such differences existed in a population of black, Hispanic, and white patients hospitalized with stroke among hospitals participating in a quality-improvement program. Methods and Resultsó We analyzed in-hospital mortality and 7 stroke performance measures among 397 257 patients admitted with ischemic stroke to 1181 hospitals participating in the Get With The Guidelines-Stroke program 2003 through 2008. Relative to white patients, black and Hispanic patients were younger and more often had diabetes mellitus and hypertension. After adjustment for both patient- and hospital-level variables, black patients had lower odds relative to white patients of receiving intravenous thrombolysis (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77 to 0.91), deep vein thrombosis prophylaxis (OR, 0.88; 95% CI, 0.83 to 0.92), smoking cessation (OR, 0.85; 95% CI, 0.79 to 0.91), discharge antithrombotics (OR, 0.88; 95% CI, 0.84 to 0.92), anticoagulants for atrial fibrillation (OR, 0.84; 95% CI, 0.75 to 0.94), and lipid therapy (OR, 0.91; 95% CI, 0.88 to 0.96), and of dying in-hospital (OR, 0.90; 95% CI, 0.85 to 0.95). Hispanic patients received similar care as their white counterparts on all 7 measures and had similar in-hospital mortality. Black (OR, 1.31; 95% CI, 1.28 to 1.35) and Hispanic (OR, 1.16; 95% CI, 1.11 to 1.20) patients had higher odds of exceeding the median length of hospital stay relative to whites. During the study, quality of care improved in all 3 race/ethnicity groups. Conclusionsó Black patients with stroke received fewer evidence-based care processes than Hispanic or white patients. These differences could lead to increased risk of recurrent stroke. Quality of care improved substantially in the Get With The Guidelines-Stroke Program over time for all 3 racial/ethnic groups.

Category: General CV

Date: 2010

Author: Lee H. Schwamm, Mathew J. Reeves, Wenqin Pan, Eric E. Smith, Michael R. Frankel, DaiWai Olson, Xin Zhao, Eric Peterson, and Gregg C. Fonarow

Abstract / Description:

Leucocyte‐directed specialized pro‐resolving mediators (SPMs) are essential for cardiac repair, and their biosynthesis coincides with the expression of pro‐inflammatory mediators; however, the precise quantitation during an acute myocardial infarction (MI) event is poorly understood in race‐specific and sex‐specific manner. Coronary heart disease is the leading cause of death and disability in the USA. Although the prevalence of coronary heart disease is similar between Black and White patients, cardiovascular events (including MI), rehospitalization, and mortality are disproportionately higher in Black patients. Therefore, understanding differences in inflammation and resolution can enable the development of predictive, personalized, and precise treatment and attenuate sex/racial disparities. Thus, herein, we assess differences in bioactive lipids and SPMs, between Black and White patients experiencing an acute MI.

Category: General CV

Date: 2020

Author: Ganesh V. Halade, Vasundhara Kain, Chrisly Dillion, Mark Beasley, Tanja Dudenbostel, Suzanne Oparil, Nita A. Limdi

Abstract / Description:

IMPORTANCEDifferences in readmission rates among racial and ethnic minorities have beenreported, but data among people with diabetes are lacking despite the high burden of diabetes andits complications in these populations.OBJECTIVESTo examine racial/ethnic differences in all-cause readmission among US adults withdiabetes and categorize patient- and system-level factors associated with these differences.DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study includes 272 758 adultpatients with diabetes, discharged alive from the hospital between January 1, 2009, and December31, 2014, and stratified by race/ethnicity. An administrative claims data set of commercially insuredand Medicare Advantage beneficiaries across the United States was used. Data analysis took placebetween October 2016 and February 2019.MAIN OUTCOMES AND MEASURESUnplanned all-cause readmission within 30 days of dischargeand individual-, clinical-, economic-, index hospitalizationñ, and hospital-level risk factors forreadmission. CONCLUSIONS AND RELEVANCEIn this study, black patients with diabetes had a significantlyhigher risk of readmission than members of other racial/ethnic groups. This increased risk was mostpronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals.

Category: Diabetes and CV

Date: 2019

Author: Rene Rodriguez-Gutierrez, MD, MSc; Jeph Herrin, PhD; Kasia J. Lipska, MD, MHS; Victor M. Montori, MD, MSc; Nilay D. Shah, PhD; Rozalina G. McCoy, MD, MS

Abstract / Description:

Background The incidence of atrial fibrillation (AF) is higher in non-Hispanic whites (NHWs) compared with other race-ethnic groups, despite more favorable cardiovascular risk profiles. To explore reasons for this paradox, we compared the hazards of AF from traditional and other risk factors between 4 race-ethnic groups in a large cohort of postmenopausal women. Methods We included 114,083 NHWs, 11,876 African Americans, 5,174 Hispanics, and 3,803 Asians from the Women's Health Initiative free of AF at baseline. Women, averaging 63 years old, were followed up for incident AF using hospitalization records and diagnostic codes from Medicare claims. Results Over a mean of 13.7 years, 19,712 incident cases of AF were recorded. Despite a higher burden of hypertension, diabetes, and obesity, annual AF incidence was lower among nonwhites (0.7%, 0.4%, and 0.4% for African American, Hispanic, and Asian participants, respectively, compared with 1.2% for NHWs). The hazards of AF from hypertension, diabetes, obesity, heart failure, and coronary artery disease were similar across race-ethnic groups. Major risk factors, including hypertension, obesity, diabetes, smoking, peripheral arterial disease, coronary artery disease, and heart failure, accounted for an attributable risk of 50.3% in NHWs, 83.1% in African Americans, 65.6% in Hispanics, and 37.4% in Asians. Established AF prediction models performed comparably across race-ethnic groups. Conclusions In this large study of postmenopausal women, traditional cardiovascular risk factors conferred a similar degree of individual risk of AF among 4 race-ethnic groups. However, major AF risk factors conferred a higher-attributable risk in African Americans and Hispanics compared with NHWs and Asians.

Category: Hispanic/Latino

Date: 2016

Author: Fatima Rodriguez MD, MPH, Marcia L. StefanickPhD, Philip Greenland MD, Elsayed Z. Soliman MD, JoAnn E. Manson MD, DrPH, Nisha Parikh MD, MPH, Lisa W. Martin MD, Joseph C. Larson MS, Mark Hlatky MD, Rami Nassir PhD, Crystal W. Cené MD, MPH, Beatriz L. Rodriguez MD, PhD, Christine Albert MD, MPH, Marco V.Perez MD

Abstract / Description:

Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age, researchers from the Centers for Disease Control and Prevention (CDC) report today in the Morbidity and Mortality Weekly Report (MMWR). Most pregnancy-related deaths are preventable. Racial and ethnic disparities in pregnancy-related deaths have persisted over time. Pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR) for black and AI/AN women older than 30 was four to five times as high as it was for white women. Even in states with the lowest PRMRs and among women with higher levels of education, significant differences persist. These findings suggest that the disparity observed in pregnancy-related death for black and AI/AN women is a complex national problem.

Category: Cardio-Obstetrics, Racism and Health

Date: 2019

Author: Centers for Disease Control and Prevention

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Abstract / Description:

In 1994, the landmark 4S trial (Scandinavian Simvastatin Survival Study) reported that lowering low-density lipoprotein (LDL) cholesterol with simvastatin reduced cardiovascular events in patients with coronary artery disease and hypercholesterolemia.1 This seminal trial crystallized our understanding of the causal role of LDL cholesterol in atherosclerosis and launched the modern era of preventive cardiology. Today, the evidence in favor of LDL cholesterol as a modifiable causal driver of atherosclerosis has never been stronger, and current therapies, such as PCSK9 inhibitors (PCSK9i), can now lower LDL cholesterol to levels never previously seen. But despite achieving very low levels of LDL cholesterol, many patients continue to have recurrent events. Although the residual risk for cardiovascular events is likely multifactorial, in certain patients a key component is a high residual burden of atherogenic lipid particles attributable to high lipoprotein(a) [Lp(a)].

Category: General CV

Date: 2019

Author: George Thanassoulis

Abstract / Description:

N/A

Category: General CV

Date: 2018

Author: Alliance for Patient Access

Abstract / Description:

OBJECTIVE: To investigate differences in severe maternal morbidity between Hispanic mothers and three major Hispanic subgroups compared with non-Hispanic white mothers and the extent to which differences in delivery hospitals may contribute to excess morbidity among Hispanic mothers. METHODS: We conducted a population-based cross-sectional study using linked 2011ñ2013 New York City discharge and birth certificate data sets (n=353,773). Rates of severe maternal morbidity were calculated using a published algorithm based on diagnosis and procedure codes. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-standardized severe maternal morbidity rates for each hospital taking into consideration patient sociodemographic characteristics and comorbidities. Differences in the distribution of Hispanic and non-Hispanic white deliveries were assessed among these hospitals in relation to their risk-adjusted morbidity. Sensitivity analyses were conducted after excluding isolated blood transfusion from the morbidity composite. RESULTS: Severe maternal morbidity occurred in 4,541 deliveries and was higher among Hispanic than non-Hispanic white women (2.7% compared with 1.5%, P

Category: Equity

Author: Elizabeth Howell;Natalia Egorova;Teresa Janevic;Amy Balbierz;Jennifer Zeitlin;Paul Hebert;

Abstract / Description:

As the Institute of Medicine defined, sex and gender have a different connotation: while sex refers to the biological aspects, gender describes the cultural factors of being male or female.1 Both play a role in medicine, first and foremost sex as it modulates cardiovascular function, as well as symptoms2 and disease presentation between males and females; some cardiovascular (CV) conditions such as heart failure with preserved ejection fraction (HFpEF)3 or even more so the Takotsubo syndrome4,5 as well as INOCA (i.e. ischaemia with non-obstructed coronary arteries6 are much more common in females than in males.

Category: General CV

Date: 2020

Author: Thomas F Lüscher, MD, FESC

Abstract / Description:

Background Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time. Methods We utilized administrative claims data from the Optum ClinformaticsÆ Datamart database from 2009 to 2015. Patients with AF with ?6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time. Results In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time. Conclusions We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

Category: General CV

Date: 2019

Author: WesleyT. OíNeal1?, AniqaB.AlamID2?, PratikB.Sandesara1á, JíNekaS.Claxton2á,RichardF. MacLehose3?, LinY.Chen4?, LindsayG.S.Bengtson5á, AlannaM.Chamberlain6á, FayeL. NorbyID3á, PamelaL. Lutsey3?, AlvaroAlonso2?*

Abstract / Description:

Background Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time. Methods We utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time. Results In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time. Conclusions We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

Category: Asian/Pacific Islander CV, Black/African American CV, Hispanic/Latino

Date: 2019

Author: Wesley T. O’Neal, Aniqa B. Alam, Pratik B. Sandesara ,J’Neka S. Claxton, Richard F. MacLehose, Lin Y. Chen ,Lindsay G. S. Bengtson, Alanna M. Chamberlain, Faye L. Norby, Pamela L. Lutsey, Alvaro Alonso

Abstract / Description:

Importance If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases. Objective To evaluate whether longitudinal patterns of blood pressure (BP) elevation differ between women and men during the life course when considering baseline BP levels as the reference. Design, Setting, and Participants We conducted sex-specific analyses of longitudinal BP measures (144?599 observations) collected for a period of 43 years (1971 to 2014) in 4 community-based US cohort studies. The combined total included 32?833 participants (54% female) spanning ages 5 to 98 years. Data were analyzed between May 4, 2019, and August 5, 2019. Exposures Age and serially assessed longitudinal BP measures: systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure (PP). Main Outcomes and Measures Sex-specific change in each primary BP measure compared with baseline BP levels, derived from multilevel longitudinal models fitted over the age span, and new-onset cardiovascular disease events. Results Of the 32?833 participants, 17?733 were women (54%). Women compared with men exhibited a steeper increase in BP that began as early as in the third decade and continued through the life course (likelihood ratio test ?2?=?531 for systolic BP; ?2?=?123 for diastolic BP; ?2?=?325 for MAP; and ?2?=?572 for PP; P for all

Category: General CV

Date: 2020

Author: Hongwei Ji, MD1,2,3; Andy Kim, BA1,2,4; Joseph E. Ebinger, MD5; Teemu J. Niiranen, MD6,7; Brian L. Claggett, PhD1; C. Noel Bairey Merz, MD4; Susan Cheng, MD, MPH, MMSc1,2,4

Abstract / Description:

The prevalence of cardiometabolic disorders in both women and men has increased worldwide and is linked to a rise in obesity and obesity-associated associated clustering of other cardiometabolic risk factors such as hypertension, impaired glucose regulation and dyslipidemia. However, the predominance of common types of cardiometabolic disorders such as heart failure, atrial fibrillation and ischemic heart disease is sex specific, and our identification of these and the underlying mechanisms is only just emerging. New evidence suggests that sex hormones, sex-specific molecular mechanisms and gender influence glucose and lipid metabolisms, as well as cardiac energy metabolism, and function. Here we review sex differences in cardiometabolic risk factors, associated preclinical and clinical cardiac disorders and potential therapeutic avenues.

Category: General CV

Date: 2019

Author: Eva Gerdts & Vera Regitz-Zagrosek

Abstract / Description:

Importance Sex differences in heart failure with preserved ejection fraction (HFpEF) have been established, but insights into the mechanistic drivers of these differences are limited. Objective To examine sex differences in cardiometabolic profiles and exercise hemodynamic profiles among individuals with HFpEF. Design, Setting, and Participants This cross-sectional study was conducted at a single-center tertiary care referral hospital from December 2006 to June 2017 and included 295 participants who met hemodynamic criteria for HFpEF based on invasive cardiopulmonary exercise testing results. We examined sex differences in distinct components of oxygen transport and utilization during exercise using linear and logistic regression models. The data were analyzed from June 2018 to May 2019. Main Outcomes and Measures Resting and exercise gas exchange and hemodynamic parameters obtained during cardiopulmonary exercise testing. Results Of 295 participants, 121 (41.0%) were men (mean [SD] age, 64 [12] years) and 174 (59.0%) were women (mean [SD] age, 61 [13] years). Compared with men, women with HFpEF in this tertiary referral cohort had fewer comorbidities, including diabetes, insulin resistance, and hypertension, and a more favorable adipokine profile. Exercise capacity was similar in men and women (percent predicted peak oxygen [O2] consumption: 66% in women vs 68% in men; P?=?.38), but women had distinct deficits in components of the O2 pathway, including worse biventricular systolic reserve (multivariable-adjusted analyses: ?LVEF ??=??1.70; SE, 0.86; P?.05; ?RVEF ??=??2.39, SE=0.80; P?=?.003), diastolic reserve (PCWP/CO: ??=?0.63; SE, 0.31; P?=?.04), and peripheral O2 extraction (C(a-v)O2 ?=-0.90, SE=0.22; P?.001)). Conclusions and Relevance Despite a lower burden of cardiometabolic disease and a similar percent predicted exercise capacity, women with HFpEF demonstrated greater cardiac and extracardiac deficits, including systolic reserve, diastolic reserve, and peripheral O2 extraction. These sex differences in cardiac and skeletal muscle responses to exercise may illuminate the pathophysiology underlying the development of HFpEF and should be investigated further.

Category: General CV

Date: 2019

Author: Emily S. Lau, MD1; Thomas Cunningham, BA1; Kathryn M. Hardin, BA1; et al

Abstract / Description:

Background Randomized controlled trials showed that newer glucose?lowering agents are cardioprotective, but most participants were men. It is unknown whether benefits are similar in women. Methods and Results Among adults with type 2 diabetes mellitus not controlled with metformin with no prior use of insulin, we assessed for sex differences in the cardiovascular effectiveness and safety of sodium?glucose?like transport?2 inhibitors (SGLT?2i), glucagon?like peptide?1 receptor agonists (GLP?1RA), dipeptidyl peptidase?4 inhibitors, initiated as second?line agents relative to sulfonylureas (reference?group). We studied type 2 diabetes mellitus American adults with newly dispensed sulfonylureas, SGLT?2i, GLP?1RA, or dipeptidyl peptidase?4 inhibitors (Marketscan?Database: 2011ñ2017). We used multivariable Cox proportional hazards models with time?varying exposure to compare time to first nonfatal cardiovascular event (myocardial infarction/unstable angina, stroke, and heart failure), and safety outcomes between drugs users, and tested for sexñdrug interactions. Among 167 254 type 2 diabetes mellitus metformin users (46% women, median age 59 years, at low cardiovascular risk), during a median 4.5?year follow?up, cardiovascular events incidence was lower in women than men (14.7 versus 16.7 per 1000?person?year). Compared with sulfonylureas, hazard ratios (HRs) for cardiovascular events were lower with GLP?1RA (adjusted HR?women: 0.57, 95% CI: 0.48ñ0.68; aHR?men: 0.82, 0.71ñ0.95), dipeptidyl peptidase?4 inhibitors (aHR?women: 0.83, 0.77ñ0.89; aHR?men: 0.85, 0.79ñ0.91) and SGLT?2i (aHR?women: 0.58, 0.46ñ0.74; aHR?men: 0.69, 0.57ñ0.83). A sex?by?drug interaction was statistically significant only for GLP?1RA (P=0.002), suggesting greater cardiovascular effectiveness in women. Compared with sulfonylureas, risks of adverse events were similarly lower in both sexes for GLP?1RA (aHR?women: 0.81, 0.73ñ0.89; aHR?men: 0.80, 0.71ñ0.89), dipeptidyl peptidase?4 inhibitors (aHR?women: 0.82, 0.78ñ0.87; aHR?men: 0.83, 0.78ñ0.87) and SGLT?2i (aHR?women: 0.68, 0.59ñ0.78; aHR?men: 0.67, 0.59ñ0.78) (all sexñdrug interactions for adverse events P>0.05). Conclusions Newer glucose?lowering drugs were associated with lower risk of cardiovascular events than sulfonylureas, with greater effectiveness of GLP?1RA in women than men. Overall, they appeared safe, with a better safety profile for SGLT?2i than for GLP?1RA regardless of sex.

Category: Diabetes and CV

Date: 2020

Author: Valeria Raparelli, Malik Elharram, Cristiano S. Moura, Michal Abrahamowicz, Sasha Bernatsky, Hassan Behlouli, and Louise Pilote

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Abstract / Description:

Background Multiple randomized controlled trials (RCTs) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease (CVD) outcomes. The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management; however, evaluation of its impact in minority populations is limited. This study intends to provide early evidence of a theory-driven intervention, Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS), using real-time videoconferencing for education and skills training. We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American (AA) population with poorly controlled type 2 diabetes. Methods The study is a two-arm, pilot controlled trial that randomizes 30 participants to the TABLETS intervention and 30 participants to a usual care group. Blinded outcome assessments will be completed at baseline, 2.5 months (immediate post-intervention), and 6.5 months (follow-up). The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices, with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention materials via videoconferencing slides and a manual of supplementary materials. The primary outcomes are physical activity, diet, medication adherence, and self-monitoring behavior, whereas the secondary outcomes are HbA1c, low-density lipoprotein cholesterol (LDL-C), BP, CVD risk, and quality of life. Discussion This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven, tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk, low-income AA population with an uncontrolled dyad or triad of CVD risk factors (diabetes with or without hypertension or hyperlipidemia). The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management. The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a subsample of patients with poor diabetes self-management. Trial registration The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier NCT02128854), available online at: http://clinicaltrials.gov/ct2/show/NCT02128854.

Category: Telehealth

Date: 2016

Author: Cheryl P. Lynch,corresponding author Joni S. Williams, Kenneth J. Ruggiero, Rebecca G. Knapp, and Leonard E. Egede

Abstract / Description:

When asked what it means to be of Indian, Pakistani, Bangladeshi, Sri Lankan, or Nepalese descent, most South Asian Americans will talk about similar things: immigration, the culture of hard work, love of food and traditions, value of family and community. What you wonít hear about is the staggering epidemic of heart disease in our communities. South Asian Americans are the second fastest growing minority group in the country, but are four times more at risk of developing heart disease than the general population. We have a much greater risk of having a heart attack before the age of 50 and we have emerged as the ethnic group with the highest prevalence of Type 2 diabetes, a very serious condition that significantly increases the risk of heart disease. These trends are not limited to those of us who have immigrated to America either: by 2020, South Asians will make up 25 percent of the worldís population but 50 percent of global cardiovascular deaths.

Category: Asian/Pacific Islander CV

Date: 2019

Author: REP. PRAMILA JAYAPAL (D-WASH.) AND GAYATHRI BADRINATH

Abstract / Description:

Background Multiple epidemiological studies from Europe and Asia have demonstrated increased cardiovascular risks associated with isolated elevation of home blood pressure (BP) or masked hypertension (MH). Previous studies have not addressed cardiovascular outcomes associated with MH and white-coat hypertension (WCH) in the general population in the United States. Objectives The goal of this study was to determine hypertensive target organ damage and adverse cardiovascular outcomes associated with WCH (high clinic BP, ?140/90 mm Hg; normal home BP,

Category: General CV

Date: 2015

Author: Danielle Tientcheu, MD,*Colby Ayers, MS,*Sandeep R. Das, MD, MPH,*Darren K. McGuire, MD, MHSC,*James A. de Lemos, MD,*Amit Khera, MD, MS,*Norman Kaplan, MD,*Ronald Victor, MD,yWanpen Vongpatanasin, MD*

Abstract / Description:

In almost 4 decades since the start of the HIV epidemic, the world has witnessed an unprecedented evolution of this disease from a debilitating and rapidly fatal syndrome to a chronic condition, effectively managed with combination antiretroviral therapy (cART). Today people living with HIV (PLWH) who receive treatment have nearly the same life expectancy as HIV?negative individuals.1 With the exception of 2 people cured by human stem?cell transplantation,2, 3 a widely applicable cure for HIV remains elusive and infection still requires lifelong therapy for PLWH. Although effective cART suppresses viral replication, inflammation and immune activation persist for PLWH and are driven by a combination of HIV?dependent and HIV?independent factors.4 These immune factors contribute to an excess of non?AIDS comorbidities in PLWH, including cardiovascular disease (CVD), frailty, malignancy, neurocognitive disease, osteoporosis, and renal and liver diseases.4 It is increasingly recognized that as the population of PLWH ages, targeting non?AIDS comorbidities is essential to effectively care for and treat this population. CVD is the leading cause of death worldwide, accounting for 56.9 million deaths in 2016.5 The relative risk of CVD in PLWH is significantly higher than in HIV?negative controls, including: higher rates of acute myocardial infarction6 and increased risk for ischemic stroke,7 heart failure,8 and sudden cardiac death.9 In fact, it is estimated that the HIV?associated risk for CVD may be similar to that of traditional risk factors such as smoking, hyperlipidemia, diabetes mellitus, and hypertension.10 Despite several studies showing the higher risk of cardiovascular events in PLWH, the greatest challenge has been defining the overarching mechanisms by which HIV?mediated immune activation and chronic inflammation increase the risk for CVD.11 This has made it difficult to identify effective interventions to target and reduce cardiovascular risk in this population despite considerable efforts. In this review, we examine the effects of HIV?associated inflammation and immune activation on the cardiovascular system with a focus on atherosclerotic CVD and discuss existing and proposed therapeutic strategies targeting inflammation to reduce CVD risk. The factors contributing to immune activation and CVD in PLWH are summarized in

Category: General CV

Date: 2020

Author: Boghuma Titanji , Christina Gavegnano, Priscilla Hsue, Raymond Schinazi, and Vincent C. Marconi

Abstract / Description:

Using telemedicine for pediatric electrophysiology was a cost-effective option to improve access to subspecialty care with enhanced patient and family satisfaction, according to data presented at Heart Rhythm Society Annual Scientific Sessions.

Category: General CV

Date: 2019

Author: N/A

Abstract / Description:

BACKGROUND: Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown. OBJECTIVE: This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes. DESIGN: This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia. PARTICIPANTS: People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ??7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor. INTERVENTION: The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service. MAIN MEASURE: The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy. RESULTS: A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, -?0.05%; 95% CI -?0.10 to 0.00%) and at follow-up (week 52, -?0.03%; -?0.07 to 0.02%, p?=?0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life. CONCLUSION: This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.

Category: Telehealth

Date: 2019

Author: Jun Yang Lee MPharm, Carina Ka Yee Chan PhD, Siew Siang Chua PhD, Chirk Jenn Ng PhD, Thomas Paraidathathu PhD, Kenneth Kwing Chin Lee PhD & Shaun Wen Huey Lee PhD

Abstract / Description:

Importance Despite considerable improvements in heart failure care, mortality rates among patients in high-income countries have changed little since the early 2000s. Understanding the reasons underlying these trends may provide valuable clues for developing more targeted therapies and public health strategies. Objective To investigate mortality rates following a new diagnosis of heart failure and examine changes over time and by cause of death and important patient features. Design, Setting, and Participants This population-based retrospective cohort study analyzed anonymized electronic health records of individuals who received a new diagnosis of heart failure between January 2002 and December 2013 who were followed up until December 2014 from the Clinical Practice Research Datalink, which links information from primary care, secondary care, and the national death registry from a subset of the UK population. The data were analyzed from January 2018 to February 2019. Main Outcomes and Measures All-cause and cause-specific mortality rates at 1 year following diagnosis. Poisson regression models were used to calculate rate ratios (RRs) and 95% confidence intervals comparing 2013 with 2002, adjusting for age, sex, region, socioeconomic status, and 17 major comorbidities. Results Of 86?833 participants, 42?581 (49%) were women, 51?215 (88%) were white, and the mean (SD) age was 76.6 (12.6) years. While all-cause mortality rates declined only modestly over time (RR comparing 2013 with 2002, 0.94; 95% CI, 0.88-1.00), underlying patterns presented explicit trends. A decline in cardiovascular mortality (RR, 0.73; 95% CI, 0.67-0.80) was offset by an increase in noncardiovascular deaths (RR, 1.22; 95% CI, 1.11-1.33). Subgroup analyses further showed that overall mortality rates declined among patients younger than 80 years (RR, 0.79; 95% CI, 0.71-0.88) but not among those older than 80 years (RR, 0.97; 95% CI, 0.90-1.06). After cardiovascular causes (898 [43%]), the major causes of death in 2013 were neoplasms (311 [15%]), respiratory conditions (243 [12%]), and infections (13%), the latter 2 explaining most of the observed increase in noncardiovascular mortality. Conclusions and Relevance Among patients with a new heart failure diagnosis, considerable progress has been achieved in reducing mortality in young and middle-aged patients and cardiovascular mortality across all age groups. Improvements to overall mortality are hindered by high and increasing rates of noncardiovascular events. These findings challenge current research priorities and management strategies and call for a greater emphasis on associated comorbidities. Specifically, infection prevention presents as a major opportunity to improve prognosis.

Category: General CV

Date: 2019

Author: Nathalie Conrad, MSc; Andrew Judge, PhD; Dexter Canoy, PhD; Jenny Tran, PhD;Ana-Catarina Pinho-Gomes, MSc; Elizabeth R. C. Millett, PhD; Gholamreza Salimi-Khorshidi, PhD;John G. Cleland, MD; John J. V. McMurray, MD; Kazem Rahimi, FRCP

Abstract / Description:

Background We evaluated the risk of cardiac death in patients with prior cancer diagnoses and compared risk by cancer type and ethnicity in a large US population. Method Utilizing the Surveillance, Epidemiology, and End Results database, data on patients with a cancer diagnosis between 2000 and 2014 were obtained. We calculated the standardized mortality ratio (SMR) of cardiac death after a cancer diagnosis and the excess risk per 10,000 person-years. We stratified the analysis according to the time interval between cancer and cardiac events, cancer site, cancer stage, and race. Results A total of 4,671,989 patients with a cancer diagnosis were included, of which 163,255 died due to cardiac causes within 10 years of diagnosis. We found a significantly higher rate of cardiac death for cancer patients [SMR=1.16, 95% confidence interval (CI) 1.15ñ1.16] compared to the general population. When observed for each cancer site, the highest SMR was after a diagnosis of hepatocellular carcinoma (SMR=2.58, 95% CI 2.45ñ2.72), pancreatic cancer (SMR=2.36, 95% CI 2.25ñ2.47), and lung cancer (SMR=2.30, 95% CI 2.27ñ2.34). Patients with metastatic disease had a higher rate of cardiac death (SMR=2.16, 95% CI 2.13ñ2.19). When stratified by ethnicity, SMR for cardiac death was 1.76, 2.28, 3.68, 2.65, and 1.84 for whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics, respectively. Conclusions Cancer patients are more vulnerable to cardiac death than the general population, especially those with nonwhite ethnicity; liver, lung, and pancreatic cancers; and history of metastasis. Healthcare providers should be aware of this risk and pay particular attention to the highest-risk groups.

Category: General CV

Date: 2019

Author: Mohamed M.Gada,b,?,Anas M.Saada,c,Muneer J.Al-Husseinid,Abdelrahman IbrahimAbushoukc,SamiSalahiac,Karim AbdurRehmana,HarisRiaza,Haitham M.Ahmede

Abstract / Description:

BACKGROUND: High awareness that cardiovascular disease is the leading cause of death (LCOD) among women is critical to prevention. This study evaluated longitudinal trends in this awareness among women. METHODS AND RESULTS: Online surveys of US women (≥25 years of age) were conducted in January 2009 and January 2019. Data were weighted to the US population distribution of sociodemographic characteristics. Multivariable logistic regression was used to evaluate knowledge of the LCOD. In 2009, awareness of heart disease as the LCOD was 65%, decreasing to 44% in 2019. In 2019, awareness was greater with older age and increasing education and lower among nonWhite women and women with hypertension. The 10-year awareness decline was observed in all races/ethnicities and ages except women ≥65 years of age. The greatest declines were among Hispanic women (odds ratio of awareness comparing 2019 to 2009, 0.14 [95% CI, 0.07–0.28]), non-Hispanic Black women (odds ratio, 0.31 [95% CI, 0.19–0.49]), and 25- to 34-year-olds (odds ratio, 0.19 [95% CI, 0.10–0.34]). In 2019, women were more likely than in 2009 to incorrectly identify breast cancer as the LCOD (odds ratio, 2.59 [95% CI, 1.86–3.67]), an association that was greater in younger women. Awareness of heart attack symptoms also declined. CONCLUSIONS: Awareness that heart disease is the LCOD among women declined from 2009 to 2019, particularly among Hispanic and non-Hispanic Black women and in younger women (in whom primordial/ primary prevention may be most effective). An urgent redoubling of efforts by organizations interested in women’s health is required to reverse these trends.

Category: Black/African American CV

Date: 2020

Author: Mary Cushman, Christina M. Shay, Virginia J. Howard, Monik C. Jiménez, Jennifer Lewey, Jean C. McSweeney, L. Kristin Newby, Ram Poudel, Harmony R. Reynolds, Kathryn M. Rexrode, Mario Sims, Lori J. Mosca, and On behalf of the American Heart Association

Abstract / Description:

For older adults, heart failure (HF) has the highest 30-day hospital readmission rate of any chronic illness. Despite research into strategies to reduce readmissions, no single program has emerged as sustainable. The purpose of the current study was to test a researcher-developed home health nurse HF intervention (CareNavRNô) on 30-day readmission rates, HF knowledge, self-care, and quality of life (QOL) among 40 older adults transitioning home. Home health nurses received specialized HF training and visited patients once per week at home for 4 weeks. The control group (n = 21) had six readmissions (29%) and the intervention group (n = 19) had three readmissions (16%); however, the results were underpowered and statistically nonsignificant. Pre-/post-surveys demonstrated significant improvement in HF knowledge (p = 0.043), self-care confidence (p = 0.003), and QOL (p

Category: General CV

Date: 2020

Author: Mary Ann Leavitt, PhD, RN, CHFN-K, CCRN-K; Debra J. Hain, PhD, ARNP, AGPCNP-BC, FAANP, FNKF; Kathryn B. Keller, PhD, RN, CNE; David Newman, PhD, MA, MS

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Abstract / Description:

The South is home to the overwhelming majority of these 25 communities. Blood Flow Barrier About 800,000 people in the United States experience a stroke every year, and having one increases the risk of having another, according to the Centers for Disease Control and Prevention. Strokes occur either when blood traveling to the brain is blocked ñ an attack known as an ischemic stroke ñ or when a blood vessel inside the brain bursts, known as a hemorrhagic stroke. These incidents spark the death of brain tissue, according to the CDC, which then can cause brain damage, disability and death. Strokes kill about 140,000 Americans annually. Among adults 35 and older, stroke death rates by county in recent years were especially high in the Southern U.S., a CDC map shows. High blood pressure, high cholesterol, smoking, obesity and diabetes are leading causes of stroke, the CDC reports, and "1 in 3 U.S. adults have at least one of these conditions or habits." [ RELATED: Stroke Death Rates Are Highest in These States ] About 80% of strokes are preventable, with high blood pressure the "single most important treatable risk factor," the CDC says. Eating a healthy diet low in sodium and featuring lots of fruits and vegetables, being physically active, not smoking and limiting alcohol consumption are lifestyle factors that can help people curb their risk of a stroke, according to the federal agency. Anyone ñ including children ñ can have a stroke, though the risk of experiencing one increases with age. Based on publicly available CDC data, these are the counties and county equivalents with the highest age-adjusted death rates from strokes per 100,000 standard population in 2017, along with the ranking of their home state by stroke death rate.

Category: Stroke

Date: 2019

Author: †Katelyn Newman

Abstract / Description:

As the coronavirus spreads across the country, millions of Americans already struggling with health and finances ó especially those in minority communities ó could bear the brunt of it

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: LIZ ESSLEY WHYTE and CHRIS ZUBAK-SKEES

Abstract / Description:

As the coronavirus spreads across the country, millions of Americans already struggling with health and finances — especially those in minority communities — could bear the brunt of it. New data released Tuesday by the Centers for Disease Control and Prevention show that COVID-19 patients with underlying health issues in the United States are more likely to need treatment in a hospital — or even in an intensive care unit. They are also at higher risk of dying, according to earlier epidemiological data from both China and the U.S.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: LIZ ESSLEY WHYTE, CHRIS ZUBAK-SKEES

Abstract / Description:

Health disparities refer to the differences between people that can impact how frequently a disease affects a particular group. While some Americans are experiencing improvements in cardiovascular health, others belong to vulnerable populations and experience social or economic obstacles. These obstacles stem from characteristics historically linked to discrimination or exclusion such as race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location, and disability status.1 It is difficult to identify the individual contributions each of the obstacles have on differences in health when there are multiple connections between these factors that may result in disparities.

Category: General CV

Date: 2014

Author: Centers for Disease Control and Prevention (CDC)

Abstract / Description:

Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.

Category: Black/African American CV

Date: 2020

Author: Aditi Nayak, Albert J. Hicks, Alanna A. Morris

Abstract / Description:

Background Underuse of cardiovascular medications for secondary prevention among individuals with peripheral artery disease (PAD) has been reported. Little is known about PAD treatment status in the Hispanic/Latino population in the United States, who may have limited access to health care and who have worse clinical outcomes than non‐Hispanic individuals. Methods and Results We studied the use of cardiovascular therapies in 1244 Hispanic/Latino individuals recruited from 4 sites in the United States, including 826 individuals who reported diagnosis of PAD by physician and 418 individuals with coronary artery disease alone, in the Hispanic Community Health Study/Study of Latinos. We compared the prevalence of using antiplatelet therapy, lipid‐lowering therapy and antihypertensive therapy by PAD and coronary artery disease status. Among those with PAD, we studied factors associated with taking cardiovascular medications, including demographic and socioeconomic factors, acculturation, access to health care and comorbidities, using multivariable regression models. The overall prevalence for individuals with PAD taking antiplatelet therapy, lipid‐lowering therapy and, among hypertensive individuals, antihypertensive therapy was 31%, 26% and 57%, respectively. Individuals of Mexican background had the lowest use for all classes of cardiovascular medications. Older age, number of doctor visits and existing hypertension and diabetes mellitus were significantly associated with taking cardiovascular therapies in adjusted models. Compared with those with PAD alone, individuals with PAD and concurrent coronary artery disease were 1.52 (95% CI, 1.20–1.93) and 1.74 (1.30–2.32) times more likely to use antiplatelet agents and statins according to multivariable analysis. No significant difference of antihypertensive medication use was found among PAD patients with or without coronary artery disease. Conclusions Hispanic/Latino individuals with known PAD underuse cardiovascular medications recommended in clinical guidelines. More efforts should be directed to improve treatment in this important group.

Category: General CV, Hispanic/Latino

Date: 2020

Author: Simin Hua, Carmen R. Isasi, Jorge R. Kizer, Kunihiro Matsushita, Matthew A. Allison, Wassim Tarraf, Qibin Qi, Sonia G. Ponce, Martha Daviglus, and Robert C. Kaplan

Abstract / Description:

Underuse of cardiovascular medications for secondary prevention among individuals with peripheral artery disease (PAD) has been reported. Little is known about PAD treatment status in the Hispanic/Latino population in the United States, who may have limited access to health care and who have worse clinical outcomes than non‐Hispanic individuals.

Category: Hispanic/Latino

Date: 2020

Author: Simin Hua, Carmen R. Isasi, Jorge R. Kizer, Kunihiro Matsushita, Matthew A. Allison, Wassim Tarraf, Qibin Qi, Sonia G. Ponce, Martha Daviglus, and Robert C. Kaplan

Abstract / Description:

ATLANTA ó Despite the improvements that have been made in cholesterol reduction, more efforts are needed to improve usage rates of cholesterol-lowering medications in patients, including those with familial hypercholesterolemia, according to a presentation at the FH Foundationís FH Global Summit. Rear Admiral Betsy L. Thompson, MD, MSPH, DrPH, assistant surgeon of the U.S. Public Health Service and director of the division for heart disease and stroke prevention at the National Center for Chronic Disease Prevention and Health Promotion at the CDC, said the division has several goals: reduce the risk for hypertension and hypercholesterolemia, improve management and control of hypertension and hypercholesterolemia and to reduce the burden of stroke and heart disease.

Category: General CV

Date: 2019

Author: N/A

Abstract / Description:

  Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m2) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults.

Category: Black/African American CV, General CV

Author: Aisha T. Langford, Oluwasegun P. Akinyelure, Tony L. Moore Jr, George Howard, Yuan-I Min, William B. Hillegass, Adam P. Bress, Gabriel S. Tajeu, Mark Butler, Byron C. Jaeger, Yuichiro Yano, Daichi Shimbo, Gbenga Ogedegbe, David Calhoun, John N. Booth III, Paul Muntner

Abstract / Description:

Objective To characterize unusual responses to PCSK9 inhibitor (PCSK9i) therapy in a real-world setting, given their extremely low prevalence in clinical trials. Methods A retrospective study of patients seen in a structured academic PCSK9i clinic who had LDL-C measurements before and after initiation of PCSK9i (up to 12 months). Unusual response was defined as: (1) no response: no changes in LDL-C level at all time points; (2) delayed response: <30% LDL-C reduction by the third dose, but achieving this threshold at a later time; (3) reduced response: <30% LDL-C reduction at all time points; and (4) lost response: ≥30% LDL-C reduction by the third dose, but displaying <30% reduction at a later time. Results Of the 411 patients meeting inclusion criteria, 54 were initially classified as unusual responders. After excluding those not adherent to prescribed interventions, 31 patients (7.5%) were classified as true unusual responders. These included: 2 with no response, 12 with delayed response, 3 with reduced response, 6 with delayed or reduced response, 4 with lost response, and 4 with delayed and lost response. Response to PCSK9i therapy at all time points revealed higher on-treatment LDL-C values (94–100 vs. 47–51 ​mg/dL, p ​< ​0.001) and lower degree of percent reduction in LDL-C (23.3–34% vs. 61.1–64.5%, p ​< ​0.001) in the unusual versus usual responders. Lipoprotein (a) (Lp[a]) values were consistently higher in the unusual responders (81–92.5 vs. 28.5–52 ​mg/dL, p ​< ​0.01). Fold change in post-versus pre-treatment PCSK9 plasma results was similar between the two cohorts (p ​> ​0.05), suggesting that unusual responses were not due to insufficient plasma PCSK9 blockade. Multiple logistic regression analysis identified clinical FH (OR 2.9, 95% CI 1.27-7.24) and no ezetimibe therapy (OR 0.334, 95% CI 0.150-0.728) as factors related to true unusual response. Conclusions Unusual responses to PCSK9i in a clinical cohort are more common than reported in clinical trials. Of the suspected unusual responders, nearly half were the result of adherence issues, and thus careful medication reconciliation should be the first step in diagnosing an unusual response.

Category: Clinical trials

Date: 2020

Author: Bruce A. Wardena, Joshua R.Miles, Carlota Oleaga, Om P.Ganda, P. Barton Duella, Jonathan Q.Purnella, Michael D.Shapiroa, Sergio Fazioa

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Abstract / Description:

E-cigarettes are not a safer alternative to tobacco as far as strokes are concerned, according to a new study. Young adults who use tobacco and e-cigarettes are nearly twice as likely to have a stroke as those who smoke only traditional cigarettes and almost three times as likely as nonsmokers, researchers say.

Category: Tobacco

Date: 2020

Author: Steven Reinberg

Abstract / Description:

A new study found that if smokers were to switch to e-cigarettes, their stroke risk would not change.

Category: Tobacco

Date: 2020

Author: HealthDay

Abstract / Description:

Background: Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery. Methods: A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes.Results: Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable. Conclusion: Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

Category: Cardio-Obstetrics

Date: 2019

Author: Ahmed Hasanin; Sara Habib; Yaser Abdelwahab; Mohamed Elsayad; Maha Mostafa; Marwa Zayed; Mohamed Maher Kamel; Kareem Hussein; Sherin Refaat; Ahmed Y. Fouda; Ahmed A. Wali; Khaled A. Elshafaei; Doaa Mahmoud; Sarah Amin

Abstract / Description:

Lower extremity peripheral artery disease (PAD) burden differs by race/ethnicity. Although familial aggregation and heritability studies suggest a genetic basis, little is known about the genetic susceptibility to PAD, especially in non-European descent populations. Genome-wide association studies (GWAS) of the ankle brachial index (ABI) and PAD (defined as an ABI?0.90) have not been conducted in Hispanics/Latinos. We performed a GWAS of PAD and the ABI in 7,589 participants aged >45 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We also performed GWAS for ABI stratified by Hispanic/Latino ethnic subgroups: Central American, Mexican, and South American (Mainland group), and Cuban, Dominican, and Puerto Rican (Caribbean group). We detected two genome-wide significant associations for the ABI in COMMD10 in Puerto Ricans, and at SYBU in the Caribbean group. The lead SNP rs4466200 in the COMMD10 gene had a replication p?=?0.02 for the ABI in Multi-Ethnic Study of Atherosclerosis (MESA) African Americans, but it did not replicate in African Americans from the Cardiovascular Health Study (CHS). In a regional look-up, a nearby SNP rs12520838 had Bonferroni adjusted p?=?0.05 (unadjusted p?=?7.5?◊?10-5) for PAD in MESA Hispanics. Among three suggestive associations (p?10-7) in subgroup-specific analyses, DMD on chromosome X, identified in Central Americans, replicated in MESA Hispanics (p?=?2.2?◊?10-4). None of the previously reported ABI and PAD associations in whites generalized to Hispanics/Latinos.

Category: Hispanic/Latino

Date: 2019

Author: Sofer T1,2, Emery L3, Jain D3, Ellis AM4, Laurie CC3, Allison MA5, Lee J6, Kurniansyah N6, Kerr KF3, Gonz·lez HM7, Tarraf W8, Criqui MH5, Lange LA9, Palmas WR10, Franceschini N11, Wassel CL12.

Abstract / Description:

Kendrick Sampson attended a peaceful protest in Pan Pacific Park in Los Angeles two weeks ago, which left him scarred in more ways than one. During that protest against police brutality, he was shot by officers seven times with rubber bullets and beaten with batons, leaving him with lingering mental and physical wounds. “We have never prioritized mental health in this country,” said Sampson, an actor and activist, speaking Monday at a Los Angeles City Council meeting where he and other Black Lives Matter Los Angeles representatives advocated for changes to the city’s budget. “Black and indigenous and brown folk in this country need healing, deserve healing, but instead are met by more trauma by these systems.”

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Sandhya Raman

Abstract / Description:

Background: Approximately 700 women die from pregnancy-related complications in the United States every year. Methods: Data from CDC’s national Pregnancy Mortality Surveillance System (PMSS) for 2011–2015 were analyzed. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics. The distribution of pregnancy-related deaths by timing relative to the end of pregnancy and leading causes of death were calculated. Detailed data on pregnancy-related deaths during 2013–2017 from 13 state maternal mortality review committees (MMRCs) were analyzed for preventability, factors that contributed to pregnancy-related deaths, and MMRC-identified prevention strategies to address contributing factors. Results: For 2011–2015, the national PRMR was 17.2 per 100,000 live births. Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white (white) women (13.0). Timing of death was known for 87.7% (2,990) of pregnancy-related deaths. Among these deaths, 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% 1–6 days postpartum, 21.4% 7–42 days postpartum, and 11.7% 43–365 days postpartum. Leading causes of death included cardiovascular conditions, infection, and hemorrhage, and varied by timing. Approximately sixty percent of pregnancy-related deaths from state MMRCs were determined to be preventable and did not differ significantly by race/ethnicity or timing of death. MMRC data indicated that multiple factors contributed to pregnancy-related deaths. Contributing factors and prevention strategies can be categorized at the community, health facility, patient, provider, and system levels and include improving access to, and coordination and delivery of, quality care. Conclusions: Pregnancy-related deaths occurred during pregnancy, around the time of delivery, and up to 1 year postpartum; leading causes varied by timing of death. Approximately three in five pregnancy-related deaths were preventable. Implications for Public Health Practice: Strategies to address contributing factors to pregnancy-related deaths can be enacted at the community, health facility, patient, provider, and system levels.

Category: Racism and Health

Date: 2019

Author: Emily E. Petersen, MD; Nicole L. Davis, PhD; David Goodman, PhD; Shanna Cox, MSPH; Nikki Mayes; Emily Johnston, MPH1; Carla Syverson, MSN; Kristi Seed; Carrie K. Shapiro-Mendoza, PhD; William M. Callaghan, MD; Wanda Barfield, MD

Abstract / Description:

Introduction: Despite decades-long reductions in cardiovascular disease (CVD) mortality, CVD mortality rates have recently plateaued and even increased in some subgroups, and the prevalence of CVD risk factors remains high. Million Hearts 2022, a 5-year initiative, was launched in 2017 to address this burden. This report establishes a baseline for the CVD risk factors targeted for reduction by the initiative during 2017ñ2021 and highlights recent changes over time. Methods: Risk factor prevalence among U.S. adults was assessed using data from the National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and National Health Interview Survey. Multivariate analyses were performed to assess differences in prevalence during 2011ñ2012 and the most recent cycle of available data, and across subgroups. Results: During 2013ñ2014, the prevalences of aspirin use for primary and secondary CVD prevention were 27.4% and 74.9%, respectively, and of statin use for cholesterol management was 54.5%. During 2015ñ2016, the average daily sodium intake was 3,535 mg/day and the prevalences of blood pressure control, combustible tobacco use, and physical inactivity were 48.5%, 22.3%, and 29.1%, respectively. Compared with 2011ñ2012, significant decreases occurred in the prevalences of combustible tobacco use and physical inactivity; however, a decrease also occurred for aspirin use for primary or secondary prevention. Disparities in risk factor prevalences were observed across age groups, genders, and racial/ethnic groups. Conclusions and Implications for Public Health Practice: Millions of Americans have CVD risk factors that place them at increased risk for having a cardiovascular event, despite the existence of proven strategies for preventing or managing CVD risk factors. A concerted effort to implement these strategies will be needed to prevent one million acute cardiovascular events during the 5-year initiative.

Category: General CV

Date: 2018

Author: Hilary K. Wall, MPH1; Matthew D. Ritchey, DPT1; Cathleen Gillespie, MS1; John D. Omura, MD2; Ahmed Jamal, MBBS3; Mary G. George, MD1

Abstract / Description:

Background: Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions. Methods: Trends during 1999ñ2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions. Results: During 1999ñ2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged

Category: Black/African American CV

Date: 2017

Author: Morbidity and Mortality Weekly Report

Abstract / Description:

ntroduction: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ?35 years by age, sex, race/ethnicity, state, and census region. Methods: Trends in the rates of stroke as the underlying cause of death during 2000ñ2015 were analyzed using data from the National Vital Statistics System. Joinpoint software was used to identify trends in stroke death rates, and the excess number of stroke deaths resulting from unfavorable changes in trends was estimated. Results: Among adults aged ?35 years, age-standardized stroke death rates declined 38%, from 118.4 per 100,000 persons in 2000 to 73.3 per 100,000 persons in 2015. The annual percent change (APC) in stroke death rates changed from 2000 to 2015, from a 3.4% decrease per year during 2000ñ2003, to a 6.6% decrease per year during 2003ñ2006, a 3.1% decrease per year during 2006ñ2013, and a 2.5% (nonsignificant) increase per year during 2013ñ2015. The last trend segment indicated a reversal from a decrease to a statistically significant increase among Hispanics (APC = 5.8%) and among persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states, and during 2013ñ2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline could have been sustained. Conclusions and Implications for Public Health Practice: Prior declines in stroke death rates have not continued in recent years, and substantial variations exist in timing and magnitude of change by demographic and geographic characteristics. These findings suggest the importance of strategically identifying opportunities for prevention and intervening in vulnerable populations, especially because effective and underused interventions to prevent stroke incidence and death are known to exist.

Category: Stroke

Date: 2017

Author: Quanhe Yang, PhD1; Xin Tong, MPH1; Linda Schieb, MSPH1; Adam Vaughan, PhD1; Cathleen Gillespie, MS1; Jennifer L. Wiltz, MD1; Sallyann Coleman King, MD1; Erika Odom, PhD1; Robert Merritt, MA1; Yuling Hong, MD, PhD1; Mary G. George, MD

Abstract / Description:

Introduction: Despite its preventability, cardiovascular disease remains a leading cause of morbidity, mortality, and health care costs in the United States. This study describes the burden, in 2016, of nonfatal and fatal cardiovascular events targeted for prevention by Million Hearts 2022, a national initiative working to prevent one million cardiovascular events during 2017ñ2021. Methods: Emergency department (ED) visits and hospitalizations were identified using Healthcare Cost and Utilization Project databases, and deaths were identified using National Vital Statistics System data. Age-standardized Million Heartsñpreventable event rates and hospitalization costs among adults aged ?18 years in 2016 are described nationally and across states, as data permit. Expected 2017ñ2021 event totals and hospitalization costs were estimated assuming 2016 values remain unchanged. Results: Nationally, in 2016, 2.2 million hospitalizations (850.9 per 100,000 population) resulting in $32.7 billion in costs, and 415,480 deaths (157.4 per 100,000) occurred. Hospitalization and mortality rates were highest among men (989.6 and 172.3 per 100,000, respectively) and non-Hispanic blacks (211.6 per 100,000, mortality only) and increased with age. However, 805,000 hospitalizations and 75,245 deaths occurred among adults aged 18ñ64 years. State-level variation occurred in rates of ED visits (from 56.4 [Connecticut] to 274.8 per 100,000 [Kentucky]), hospitalizations (484.0 [Wyoming] to 1670.3 per 100,000 [DC]), and mortality (111.2 [Vermont] to 267.3 per 100,000 [Mississippi]). Approximately 16.3 million events and $173.7 billion in hospitalization costs could occur during 2017ñ2021 without preventive intervention. Conclusions and Implications for Public Health Practice: Million Heartsñpreventable events place a considerable health and economic burden on the United States. With coordinated efforts, many of these events could be prevented in every state to achieve the initiativeís goal.

Category: General CV

Date: 2018

Author: Matthew D. Ritchey, DPT1; Hilary K. Wall, MPH1; Pamela L. Owens, PhD2; Janet S. Wright, MD1

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Abstract / Description:

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the United States, and increasing physical activity can help prevent and manage disease. Walking is an easy way for most adults to be more active and may help people at risk for CVD avoid inactivity, increase their physical activity levels, and improve their cardiovascular health. To guide efforts that promote walking for CVD prevention and management, we estimated the prevalence of walking among US adults by CVD risk status. Methods: Nationally representative data on walking from participants (N = 29,742) in the 2015 National Health Interview Survey Cancer Control Supplement were analyzed. We estimated prevalence of walking (ie, any, transportation, and leisure) overall and by CVD status. We defined CVD status as either not having CVD and not at risk for CVD; being at risk for CVD (overweight or having obesity plus 1 or more additional risk factors); or having CVD. We defined additional risk factors as diabetes, high cholesterol, or hypertension. Odds ratios were estimated by using logistic regression models adjusted for respondent characteristics.Results: Prevalence of any walking decreased with increasing CVD risk (no CVD/not at risk, 66.6%; at risk: overweight or has obesity with 1 risk factor, 63.0%; with 2 risk factors, 59.5%; with 3 risk factors, 53.6%; has CVD, 50.2%). After adjusting for respondent characteristics, the odds of any walking and leisure walking decreased with increasing CVD risk. However, CVD risk was not associated with walking for transportation. Conclusions: Promoting walking may be a way to help adults avoid inactivity and encourage an active lifestyle for CVD prevention and management.

Category: General CV

Author: John D. Omura, MD; Emily N. Ussery, PhD; Fleetwood Loustalot, PhD; Janet E. Fulton, PhD; Susan A. Carlson, PhD

Abstract / Description:

Preparing for and overcoming any disaster, such as the current coronavirus pandemic, requires healthy and resilient communities. However, after age, obesity is the biggest risk factor for being hospitalized with COVID-19. And the U.S. has one of the highest obesity rates in the world, with drastic disparities among racial/ethnic groups, including the highest rates among Latinos. To beat COVID-19, we need healthier communities that prevent obesity and leaders who prioritize equitable access to healthy food, housing, and safe spaces to walk and bike instead of space for cars. “We in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not,” said Dr. Matthew Hutter, director of the Weight Center at Massachusetts General Hospital and president of the American Society for Metabolic and Bariatric Surgery, according to the New York Times. “It makes people sick, and we’re realizing that now.”

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Amanda Merck

Abstract / Description:

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism. Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis. Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19. Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

Category: COVID-19 Impact on Minority Health, Racism and Health

Date: 2020

Author: Adrienne Milner, Berkeley Franz, and Jomills Henry Braddock

Abstract / Description:

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Category: General CV

Author: American College of Cardiology

Abstract / Description:

Introduction Both short and long sleep have been associated with higher mortality. However, most studies are conducted in predominantly White or Asian populations and little is known about the sleep-mortality relationship in Blacks. Given the high prevalence of short and long sleep in Blacks, it is important to examine the health effects of sleep in this population. Methods We studied sleep duration in relation to all-cause, cardiovascular and cancer mortality in 55,375 participants age 40ñ79 at enrollment in the Southern Community Cohort Study, of whom ?2/3 are Black. Weekday and weekend sleep durations were self-reported. Mortality follow up started at baseline (2002ñ2009) and was regularly updated until 2015 via linkage to Social Security Administration and the National Death Index. We used Cox proportional hazards model adjusting for multiple covariates to estimate relative risks associated with sleep duration. Results We found U-shaped relationships between weekday and weekend sleep duration and all-cause mortality, with the effects stronger in Whites than Blacks. Risks for all-cause mortality were significantly elevated by about 25% among Whites and about 10% among Blacks reporting either less than 5 hours or more than 9 hours of sleep compared with those reporting 8 hours of sleep. The associations among Whites but not Blacks were even stronger for cardiovascular disease mortality, whereas no association between sleep duration and cancer mortality was found in either group. Conclusions Our results suggest that short and long sleep durations may be weaker predictors of total and cardiovascular mortality in Blacks than in Whites.

Category: Black/African American CV

Date: 2019

Author: Qian Xiao, PhDa,b,*,WilliamJ.Blot,PhDc, Charles E. Matthews, PhDd

Abstract / Description:

As the coronavirus pandemic spread across the United States, it has disproportionately struck communities of color, particularly African Americans. As a recent ProPublica Illinois article revealed, of the first 100 recorded deaths from the coronavirus in Chicago, 70 of the victims were African American.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: ProPublica

Abstract / Description:

Approximately seven million people around the world die from heart attacks every year. And cardiovascular disease, which causes heart attacks and other problems like strokes, is the worldís leading killer. So what causes a heart attack? Krishna Sudhir examines the leading causes and treatments of this deadly disease.

Category: General CV

Date: 2017

Author: Krishna Sudhir

Abstract / Description:

The COVID-19 pandemic has wreaked havoc across the globe, devastating economies, slashing millions of jobs and creating a health crisis like many have never seen before. But to say that the coronavirus is an indiscriminate predator would be misleading, as minorities face a much higher fatality rate at the hands of the respiratory illness than do their counterparts.

Category: COVID-19 Impact on Minority Health, Equity

Date: 2020

Author: Erin Dobrzyn, Gabriella Nuñez

Abstract / Description:

I dread every time my partner leaves our home. I dread every time Sadiqa marches to the front lines of the war against COVID-19—the emergency department. I dread every time she comes home and removes her personal protective equipment. Sadiqa is worried like a soldier in a total war, seeing so many medical providers going down, seeing so many patients going down. I am worried about her health—and my own, as someone surviving metastatic cancer. I am worried about all medical providers, all Americans who have compromised immune systems, all Americans who are infected, all Americans who are healthy and want to remain that way.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Ibram X. Kendi

Year: 2020

Abstract / Description:

Lack of access to structural support, sick leave and technology, and a mistrust of doctors and hospitals are among the social factors that contribute to health inequities among people of color, according to Linda Rae Murray, MD, MPH, a past president of the American Public Health Association and a leader in Chicago’s health community for more than 40 years. And in the COVID-19 pandemic, health inequity can be a killer. While people of color in the U.S. have long experienced unequal access to health care, “this global pandemic gives us an opportunity to really look carefully at health inequities,” Dr. Murray said during a JAMA Network™ livestreamed video interview.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Len Strazewski

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Abstract / Description:

Background Asian?American subgroups (Asian?Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian?American subgroups compared with non?Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race?specific life expectancy, mean years of potential life lost, and years of potential life lost per 100 000 population for each Asian subgroup and non?Hispanic whites. Asian?American subgroups display heterogeneity in cardiovascular disease burden. Asian?Indians had a high burden of ischemic heart disease; Asian?Indian men lost 724 years per 100 000 population in 2012 and a mean of 17 years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16 years of life to cerebrovascular disease; Filipino men lost 352 years per 100 000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non?Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian?Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup?specific interventions are required to address these health disparities.

Category: Asian/Pacific Islander CV

Date: 2019

Author: Divya G. Iyer, Nilay S. Shah, Katherine G. Hastings, Jiaqi Hu, Fatima Rodriguez, Derek B. Boothroyd, Aruna V. Krishnan, Titilola Falasinnu, and Latha Palaniappan

Abstract / Description:

Abstract Objective: To quantify the impact of cardiovascular disease and its subtypes on the premature mortality of Hispanics in the United States. Methods: We used national death records to identify deaths for the three largest His­panic subgroups (Mexicans, Puerto Ricans, and Cubans) in the United States from 2003 to 2012 (N = 832,550). We identi­fied all deaths from cardiovascular disease and by subtype (ie, ischemic, cerebrovas­cular, hypertensive and heart failure) using the underlying cause of death via ICD-10 codes. Years of potential life lost (YPLL) was calculated by age categories standard­izing with the 2000 US Census population. Population estimates were calculated using linear interpolation from 2000 and 2010 US Census data. Results: After standardization, Puerto Ricans experienced the highest YPLL for all types of cardiovascular disease compared with Mexicans and Cubans (1,139 years per 100,000 compared with 868 and 841, respectively), a disparity that remained con­sistent over the course of a decade. Among different subcategories of cardiovascular disease, Puerto Ricans had the highest YPLL for ischemic and hypertensive heart disease, while Mexicans had the highest YPLL from cerebrovascular disease. Conclusions: In conclusion, disaggregation of Hispanic subgroups revealed marked heterogeneity in premature cardiovascu­lar mortality. These findings suggest that measures to improve the cardiovascular health of Hispanics should incorporate sub­group status as a key part of public health strategy

Category: Hispanic/Latino

Date: 2019

Author: Lakshman Manjunath, Jiaqi Hu, Latha Palaniappan, Fatima Rodriguez

Abstract / Description:

Statin use among patients with ovarian cancer was associated with a large reduction in cancer-specific mortality, an observational study of Finnish women found. Among over 10,000 epithelial ovarian cancer patients, those that used any type of statin had a 40% reduction in ovarian cancer mortality compared with never-users (HR 0.60, 95% CI 0.54-0.66) and a 37% reduction in 5-year mortality (HR 0.63, 95% CI 0.56-0.70), reported Kala Visvanathan, MD, MHS, of Johns Hopkins Medicine in Baltimore.

Category: General CV

Date: 2020

Author: Ian Ingram

Abstract / Description:

There are many ways to measure health, but one stands out as a key to longevity and wellness: blood pressure. While it might seem like a trivial part of your yearly check-ups, the truth is that monitoring blood pressure gives you a quick and clear indicator of how your heart is doing. First, the basics: Blood pressure is just a measurement of the pressure it takes for your heart to pump blood through your body. The biggest concern for most people, especially as they age, is high blood pressure. Also known as hypertension, high blood pressure is when the pressure stays high over significant time, according to the Centers for Disease Control (CDC). High blood pressure can lead to a whole host of issues in the long term. Namely, it contributes to the leading causes of death in the US: heart disease and stroke.

Category: General CV

Date: 2019

Author: COLLEEN STINCHCOMBE

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Abstract / Description:

While the COVID-19 pandemic forced other healthcare organizations to spend March and April shuttering their doors and transitioning to telehealth care access options, Cahaba Medical Care in Alabama was doing the opposite The federally qualified health center (FQHC) with ten clinics, a fleet of school-based providers, and two community-based centers in the Birmingham area knew that in order to promote health equity, they couldn’t shut down completely. Of course, telehealth gained international notoriety during the pandemic for helping to connect patients to care during strict stay-at-home orders. It helped Cahaba in this way, too. But leadership also knew that telehealth care access couldn’t tell the whole story for every patient.

Category: Equity, Telehealth

Date: 2020

Author: Sara Heath

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Abstract / Description:

Growing evidence links psychological well-being (e.g., optimism) with superior cardiac health, but there remains a critical scientific gap as we do not know whether (or how) interventions to cultivate emotional well-being may reduce cardiac risk. Hispanics/Latinos in the U.S. have high cardiovascular disease risk and poorly controlled blood pressure (BP) compared to peers of European ancestry, and represent a population in need of new and innovative therapeutic approaches. This paper details the ì°AlÈgrate!î study, a cluster-randomized Phase II trial testing efficacy in improving BP of a culturally tailored positive psychological intervention designed to boost emotional well-being in Hispanics/Latinos with hypertension. A total of 126 Hispanics/Latinos aged ?18 years, fluent in English or Spanish, and with elevated sitting BP (?140/90?mmHg) will participate in one of two trial arms: (1) a positive psychological intervention, or (2) a wait-list control condition. The ì°AlÈgrate!î group-based intervention consists of 8 weekly 90ñ120-min sessions delivered in-person by a psychologist/social worker. Targeted skills include noting daily positive events, positive reappraisal of stressful events, effective expression of gratitude, performing acts of kindness, and regular practice of mindfulness and meditation, among others. The primary outcome is improvement in BP, both sitting values and 24-h ambulatory readings, as measured at baseline and 8- and 12-weeks post-baseline. Secondary outcomes include emotional well-being, engagement in healthful behaviors, and circulating levels of inflammatory markers. We hypothesize that BP control, psychological well-being, healthful behaviors, and chronic inflammation will be significantly better in the ì°AlÈgrate!î arm at follow up compared to the wait-list control group.

Category: Hispanic/Latino

Date: 2019

Author: Rosalba Hernandeza,?, Martha L. Daviglusb,c, Lizet Martineza, Ramon A. Durazo-Arvizub,d,JeffC. Huffmane, Ferney Ramirezf, Lisett Titoa, Judith T. Moskowitz

Abstract / Description:

Background:The taxicab industry is a burgeoning occupation that predominantlyemploys immigrant males from low socioeconomic backgrounds. Factors such assedentary nature, environmental factors, high stress coupled with socioeconomicfactors may increase cardiovascular disease risk among taxicab drivers. Latinos, agrowing immigrant population make up approximately 20% of this industry. However,few studies focus on their experiences as cab drivers or on the factors that mayincrease their cardiovascular risks.Methods:This was an ethnographic qualitative study. Data was collected viaindividual interviews combined with Go?Alongs. The Go?Along is an observationalqualitative method whereby researchers accompany participants during routineactivities and make observations. Interviews and observations were transcribed andcoded to identify emerging themes.Results:Thirty?two Latino male cab drivers participated; their mean age was 45 + 12years; 47% did not finish high school; and 63% earned $30 000 or less. Time andstress emerged as dominant themes. Time constraints posed a barrier to healthyeating and physical activity. Drivers reported stress from constantly worrying abouttheir finances and personal safety. Drivers also described stress from the physical tollof driving on the body. Go?Alongs supported these themes and identified socialinteractions and environmental factors that could be leveraged for health promotion.Conclusions:This study provided an opportunity for cab drivers to describe theirperspectives on reasons why their occupation was associated with a high risk forcardiovascular disease. The Go?Alongs contributed to the understanding of the socialand environmental context that characterized cardiovascular risks in this occupation.KEYWORDScardiovascular disease risks, Go?Alongs, immigrant health, Latino health, minority menís health,qualitative study, taxicab drivers

Category: Hispanic/Latino

Date: 2019

Author: Rachel Orleans MD1|Carla Boutin?Foster MD, MS2|Ebony Scott MSEd3|Rosio Ramos BA1|Zenobia Faussett MS4|Jorge D. Lata Armijos

Abstract / Description:

Study Objectives To determine whether name and accent cues that the caller is Black shape physician officesí responses to telephone?based requests for well?child visits. Method and Data In this pilot study, we employed a quasi?experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind?coded into binary variables. Our case?control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions. Findings Compared to the control group, ìBlackî auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. Additionally, the likelihood and ways office personnel communicated that they were not accepting patients varied by region. Conclusions Linguistic profiling over the telephone is an aspect of structural racism that should be further studied and perhaps integrated into efforts to promote equitable access to care. Future research should look reactions to both name and accent, taking practice characteristics and regional differences into consideration.

Category: Black/African American CV

Date: 2018

Author: Tamara G.J. Leech, PhD,corresponding author 1 Amy Irby?Shasanmi, PhD, 2 and Anne L. Mitchell, MA 3

Abstract / Description:

Growing evidence links psychological well-being (e.g., optimism) with superior cardiac health, but there remains a critical scientific gap as we do not know whether (or how) interventions to cultivate emotional well-being may reduce cardiac risk. Hispanics/Latinos in the U.S. have high cardiovascular disease risk and poorly controlled blood pressure (BP) compared to peers of European ancestry, and represent a population in need of new and innovative therapeutic approaches. This paper details the ì°AlÈgrate!î study, a cluster-randomized Phase II trial testing efficacy in improving BP of a culturally tailored positive psychological intervention designed to boost emotional well-being in Hispanics/Latinos with hypertension. A total of 126 Hispanics/Latinos aged ?18 years, fluent in English or Spanish, and with elevated sitting BP (?140/90?mmHg) will participate in one of two trial arms: (1) a positive psychological intervention, or (2) a wait-list control condition. The ì°AlÈgrate!î group-based intervention consists of 8 weekly 90ñ120-min sessions delivered in-person by a psychologist/social worker. Targeted skills include noting daily positive events, positive reappraisal of stressful events, effective expression of gratitude, performing acts of kindness, and regular practice of mindfulness and meditation, among others. The primary outcome is improvement in BP, both sitting values and 24-h ambulatory readings, as measured at baseline and 8- and 12-weeks post-baseline. Secondary outcomes include emotional well-being, engagement in healthful behaviors, and circulating levels of inflammatory markers. We hypothesize that BP control, psychological well-being, healthful behaviors, and chronic inflammation will be significantly better in the ì°AlÈgrate!î arm at follow up compared to the wait-list control group. Keywords: Positive psychology, Hispanic/Latino, Cardiovascular disease risk, Hypertension, Cultural adaptation, Clinical trial, Cluster randomization

Category: Hispanic/Latino

Date: 2019

Author: Rosalba Hernandez,a,? Martha L. Daviglus,b,c Lizet Martinez,a Ramon A. Durazo-Arvizu,b,d Jeff C. Huffman,e Ferney Ramirez,f Lisett Tito,a and Judith T. Moskowitzg

Abstract / Description:

As legions of Philadelphians have been laid off or forced to work from their living rooms, Ashley Jimenez, the director of case management at two homeless shelters, has kept coming into work. She worries constantly about her clients, even more than usual. They are disproportionately elderly and afflicted with immune-compromising illnesses like HIV/AIDS. “This is a population who are … more susceptible to the COVID-19,” said Jimenez. “When I walk in those doors every day, I’m thinking, and it kind of goes two ways: How susceptible am I to them? And how susceptible are they to me?”

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Nina Feldman, Jake Blumgart

Abstract / Description:

Decades of inequality and institutional racism affecting black communities is becoming evident in covid-19 data, Chicago officials said Monday, as Mayor Lori Lightfoot sounded the alarm over significant racial disparities in deaths and coronavirus cases across the city. In Chicago, black Americans account for 68 percent of the cityís 118 deaths and 52 percent of the roughly 5,000 confirmed coronavirus cases, despite making up just 30 percent of the cityís population, according to data from the Chicago Department of Public Health.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: Meagan Flynn

Abstract / Description:

Stark statistics are coming to light only now and only in piecemeal fashion showing that African Americans are disproportionately affected by Covid-19. The racial divide in who gets infected, who gets tested, and who dies from Covid-19 is emerging from the few cities and states whose data are public.

Category: COVID-19 Impact on Minority Health

Date: 2020

Author: ELIZABETH COONEY

Year: 2020

Abstract / Description:

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide, accounting for 13%-15% of all deaths. Cardiac rehabilitation has poor compliance and adherence. Telerehabilitation has been introduced to increase patients' participation, access, and adherence with the help of digital technologies. The target group is patients with heart failure. A telerehabilitation program called "Future Patient" has been developed and consists of three phases: (1) titration of medicine (0-3 months), (2) implementation of the telerehabilitation protocols (3 months), and (3) follow-up with rehabilitation in everyday life (6 months). Patients in the Future Patient program measure their blood pressure, pulse, weight, number of steps taken, sleep, and respiration and answer questions online regarding their well-being. All data are transmitted and accessed in the HeartPortal by patients and health care professionals. OBJECTIVE: The aim of this paper is to describe the research design, outcome measures, and data collection techniques in the clinical test of the Future Patient Telerehabilitation Program for patients with heart failure. METHODS: A randomized controlled study will be performed. The intervention group will follow the Future Patient Telerehabilitation program, and the control group will follow the traditional cardiac rehabilitation program. The primary outcome is quality of life measured by the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes are development of clinical data; illness perception; motivation; anxiety and depression; health and electronic health literacy; qualitative exploration of patients', spouses', and health care professionals' experiences of participating in the telerehabilitation program; and a health economy evaluation of the program. Outcomes were assessed using questionnaires and through the data generated by digital technologies. RESULTS: Data collection began in December 2016 and will be completed in October 2019. The study results will be published in peer-reviewed journals and presented at international conferences. Results from the Future Patient Telerehabilitation program are expected to be published by the spring of 2020. CONCLUSIONS: The expected outcomes are increased quality of life, increased motivation and illness perception, reduced anxiety and depressions, improved electronic health literacy, and health economics benefits. We expect the study to have a clinical impact for future telerehabilitation of patients with heart failure.

Category: Telehealth

Date: 2019

Author: Birthe Dinesen1, MSc, PhD ; Lars Dittmann2, MSc, PhD ; Josefine Dam Gade, MSc ; Cecilia Klitgaard Jørgensen, MSc ; Malene Hollingdal, MD, PhD ; Soeren Leth, MSc ; Camilla Melholt, MSc ; Helle Spindler, MSc, PhD ; Jens Refsgaard, MD, PhD