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Practical use of electronic health records among patients with diabetes in scientific research. Chin Med J (Engl) 2021; 133:1224-1230. [PMID: 32433055 PMCID: PMC7249716 DOI: 10.1097/cm9.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Electronic health (medical) records, which are also considered as patients’ information that are routinely collected, provide a great chance for researchers to develop an epidemiological understanding of disease. Electronic health records systems cannot develop without the advance of computer industries. While conducting clinical trials that are always costly, feasible and reasonable analysis of routine patients’ information is more cost-effective and reflective of clinical practice, which is also called real world study. Real world studies can be well supported by big data in healthcare industry. Real world studies become more and more focused and important with the development of evidence-based medicine. These big data will definitely help in making decisions, making policies and guidelines, monitoring of effectiveness and safety on new drugs or technologies. Extracting, cleaning, and analyzing such big data will be a great challenge for clinical researchers. Successful applications and developments of electronic health record in western countries (eg, disease registries, health insurance claims, etc) have provided a clear direction for Chinese researchers. However, it is still at primary stages in China. This review tries to provide a full perspective on how to translate the electronic health records into scientific achievements, for example, among patients with diabetes. As a summary in the end, resource sharing and collaborations are highly recommended among hospitals and healthcare groups.
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Mills KT, Peacock E, Chen J, Zimmerman A, Brooks K, He H, Cyprian A, Davis G, Fuqua SR, Greer A, Gray-Winfrey L, Williams S, Wiltz GM, Winfrey KL, Whelton PK, Krousel-Wood M, He J. Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control (IMPACTS): Rationale and design of a cluster-randomized trial. Am Heart J 2020; 230:13-24. [PMID: 32827458 PMCID: PMC7437489 DOI: 10.1016/j.ahj.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) reported that intensive blood pressure (BP) treatment reduced cardiovascular disease and mortality compared to standard BP treatment in hypertension patients. The next important question is how to implement more intensive BP treatment in real-world clinical practice. We designed an effectiveness-implementation hybrid trial to simultaneously test the effectiveness of a multifaceted intervention for intensive BP treatment and its feasibility, fidelity, and sustainability in underserved hypertension patients. METHODS Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control (IMPACTS) is a cluster randomized trial conducted in 36 Federally Qualified Health Center clinics in Louisiana and Mississippi. Federally Qualified Health Center clinics were randomized to either a multifaceted intervention for intensive BP treatment, including protocol-based treatment using the SPRINT intensive BP management algorithm, dissemination of SPRINT findings, BP audit and feedback, home BP monitoring, and health coaching, or enhanced usual care. Difference in mean systolic BP change from baseline to 18 months is the primary clinical effectiveness outcome, and intervention fidelity, measured by treatment intensification and medication adherence, is the primary implementation outcome. The planned sample size of 1,260 participants (36 clinics with 35 participants each) has 90% power to detect a 5.0-mm Hg difference in systolic BP at a .05 significance level and 80% follow-up rate. CONCLUSIONS IMPACTS will generate critical data on the effectiveness and implementation of a multifaceted intervention for intensive BP treatment in real-world clinical practice and could directly impact the BP-related disease burden in minority and low-income populations in the United States.
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Affiliation(s)
- Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA
| | - Amanda Zimmerman
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Kenya Brooks
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA
| | | | | | - Sonja R Fuqua
- Community Health Center Association of Mississippi, Jackson, MS
| | | | | | | | | | | | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA; Tulane University Translational Sciences Institute, New Orleans, LA.
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Workie DL, Zike DT, Fenta HM. Bivariate longitudinal data analysis: a case of hypertensive patients at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. BMC Res Notes 2017; 10:722. [PMID: 29221495 PMCID: PMC5721485 DOI: 10.1186/s13104-017-3044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Longitudinal data are often collected to study the evolution of biomedical markers. The study of the joint evolution of response variables concerning hypertension over time was the aim of this paper. A hospital based retrospective data were collected from September 2014 to August 2015 to identify factors that affect hypertensive. The joint mixed effect model with unstructured covariance was fitted. A total of 172 patients screened for antihypertensive drugs treated were longitudinally considered from Felege Hiwot referral. Results The joint mixed effect model with unstructured covariance (AIC: 12,236.9 with \documentclass[12pt]{minimal}
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\begin{document}$$ \chi_{12}^{2} $$\end{document}χ122 = 1007.8, P < 10−4) was significantly best fit to the data. The correlation between the evolutions of DBP and SBP was 0.429 and the evolution of the association between responses over-time was found 0.257. Among all covariates included in joint-mixed-effect-models, sex, residence, related disease and time were statistically significant on evolution of systolic and diastolic blood pressure. The joint modeling of longitudinal bivariate responses is necessary to explore the association between paired response variables like systolic and diastolic blood pressure. Fitting joint model with modern computing method is recommended to address questions for association of the evolutions with better accuracy.
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Affiliation(s)
- Demeke Lakew Workie
- Department of Statistics, Bahir Dar University, Peda Campus, P.O.Box: 79, Bahir Dar, Ethiopia.
| | - Dereje Tesfaye Zike
- Department of Statistics, Bahir Dar University, Peda Campus, P.O.Box: 79, Bahir Dar, Ethiopia
| | - Haile Mekonnen Fenta
- Department of Statistics, Bahir Dar University, Peda Campus, P.O.Box: 79, Bahir Dar, Ethiopia
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Li W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. Blood pressure and all-cause mortality among patients with type 2 diabetes. Int J Cardiol 2016; 206:116-21. [PMID: 26788685 DOI: 10.1016/j.ijcard.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The recommended goal for blood pressure (BP) control has recently been adjusted for people with diabetes, but the optimal BP control range for the diabetic population is still uncertain. METHODS We performed a prospective cohort study of 35,261 patients with type 2 diabetes. Cox proportional hazard regression models were used to estimate the association of BP with all-cause mortality. RESULTS During a mean follow-up period of 8.7 years, 4199 deaths were identified. The multivariable-adjusted hazard ratios of all-cause mortality associated with different levels of systolic/diastolic BP (<110/65, 110-119/65-69, 120-129/70-80, 130-139/80-90 [reference group], 140-159/90-100, and ≥160/100 mmHg) were 1.70 (95% confidence interval [CI] 1.42-2.04), 1.26 (95% CI 1.07-1.50), 0.99 (95% CI 0.86-1.12), 1.00, 0.92 (95% CI 0.82-1.03), and 1.10 (95% CI 0.98-1.23) using baseline BP measurements, and 2.62 (95% CI 2.00-3.44), 1.77 (95% CI 1.51-2.09), 1.22 (95% CI 1.09-1.36), 1.00, 0.90 (95% CI 0.82-1.00), and 0.98 (95% CI 0.86-1.12) using an updated mean value of BP during follow-up, respectively. The U-shaped associations were confirmed in both African American and white patients, in both men and women, in those who were or were not taking antihypertensive drugs, and in patients aged 30-49 years and 50-59 years. CONCLUSIONS The current study found a U-shaped association between BP at baseline and during follow-up and the risk of all-cause mortality among patients with type 2 diabetes.
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Affiliation(s)
- Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Tianjin Women's and Children's Health Center, Tianjin, China
| | | | | | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jolene Johnson
- Louisiana State University Health Center, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Li W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. HbA1c and all-cause mortality risk among patients with type 2 diabetes. Int J Cardiol 2015; 202:490-6. [PMID: 26440458 DOI: 10.1016/j.ijcard.2015.09.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/11/2015] [Accepted: 09/21/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several prospective studies have evaluated the association between glycosylated hemoglobin (HbA1c) and death risk among diabetic patients. However, the results have been inconsistent. METHODS We performed a prospective study which included 13,334 men and 21,927 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of different levels of HbA1c with all-cause mortality. RESULTS During a mean follow up of 8.7 years, 4199 (2082 men and 2117 women) patients died. The multivariable-adjusted hazard ratios (HRs) of all-cause mortality associated with different levels of HbA1c at baseline (<6.0%, 6.0-6.9% [reference], 7.0-7.9, 8.0-8.9%, 9.0-9.9%, 10.0-10.9%, and ≥11.0%) were 1.06, 1.00, 1.10, 0.93, 1.26, 1.18 and 1.31 (Pnon-linear=0.008) for men, and 1.21, 1.00, 1.01, 1.08, 1.30, 1.30 and 1.74 (Pnon-linear<0.001) for women, respectively. The J-shaped association of HbA1c with all-cause mortality was confirmed among African American and white diabetic patients, patients who were more than 50 years old, never smoked or used insulin. When we used an updated mean value of HbA1c, the J-shaped association of HbA1c with the risk of all-cause mortality did not change. CONCLUSIONS Our study demonstrated a J-shaped association between HbA1c and the risk of all-cause mortality among men and women with type 2 diabetes. Both high and low levels of HbA1c were associated with an increased risk of all-cause mortality.
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Affiliation(s)
- Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Tianjin Women's and Children's Health Center, Tianjin, China
| | | | | | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jolene Johnson
- Louisiana State University Health Center, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence. Can J Cardiol 2015; 31:1169-79. [DOI: 10.1016/j.cjca.2015.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 02/06/2023] Open
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Li W, Katzmarzyk PT, Horswell R, Zhang Y, Wang Y, Johnson J, Hu G. Body mass index and heart failure among patients with type 2 diabetes mellitus. Circ Heart Fail 2015; 8:455-63. [PMID: 25681435 DOI: 10.1161/circheartfailure.114.001837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/10/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epidemiological data on the association between body mass index (BMI) and heart failure (HF) risk among diabetic patients are rare. METHODS AND RESULTS We performed a prospective cohort study of risk for HF among 31 155 patients with type 2 diabetes mellitus (11 468 men and 19 687 women). Cox proportional hazards regression models were used to estimate the association of different levels of BMI with HF risk. During a mean follow-up of 7.8 years, 5834 subjects developed HF (2379 men and 3455 women). The multivariable-adjusted (age, race, smoking, income, and type of insurance) hazard ratios of HF associated with BMI levels (18.5-22.9, 23-24.9, 25-29.9 [reference group], 30-34.9, 35-39.9, and ≥40 kg/m(2)) at baseline were 0.95, 1.00, 1.00, 1.16, 1.64, and 2.02 (Ptrend<0.001) for men and 1.16, 1.16, 1.00, 1.23, 1.55, and 2.01 (Pnonlinear<0.001) for women, respectively. When we used an updated mean value of BMI, the association of HF risk with BMI did not change. When stratified by age, race, smoking status, and use of antidiabetic drugs, the positive associations among men and the J-shaped associations among women were still present. CONCLUSIONS Our study suggests a positive association between BMI and HF risk among men and a J-shaped association between BMI and HF risk among women with type 2 diabetes mellitus.
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Affiliation(s)
- Weiqin Li
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Peter T Katzmarzyk
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Ronald Horswell
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Yonggang Zhang
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Yujie Wang
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Jolene Johnson
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.)
| | - Gang Hu
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, LA (J.J.).
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Zhao W, Guan J, Horswell R, Li W, Wang Y, Wu X, Hu G. HDL cholesterol and cancer risk among patients with type 2 diabetes. Diabetes Care 2014; 37:3196-203. [PMID: 25216507 PMCID: PMC4237978 DOI: 10.2337/dc14-0523] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between HDL cholesterol (HDL-C) and cancer risk among type 2 diabetic patients. RESEARCH DESIGN AND METHODS We performed a retrospective cohort study of 14,169 men and 23,176 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of various levels of HDL cholesterol (HDL-C) with cancer risk. RESULTS During a mean follow-up period of 6.4 years, 3,711 type 2 diabetic patients had a cancer diagnosis. A significant inverse association between HDL-C and the risk of cancer was found among men and women. The multivariable-adjusted hazard ratios (HRs) of cancer at various levels of HDL-C at baseline (<30, 30-39.9, 40-49.9, 50-59.9, 60-69.9, 70-79.9, and ≥80 mg/dL) were 1.00, 0.87, 0.95, 1.01, 0.61, 0.45, and 0.37, respectively, in men (Ptrend = 0.027) and 1.00, 0.98, 0.88, 0.85, 0.84, 0.86, and 0.84, respectively, in women (Ptrend = 0.025). When stratified by race, BMI, smoking status, or medication use, the inverse association was still present. With an updated mean of HDL-C used in the analysis, the inverse association of HDL-C with cancer risk did not change. The inverse association substantially attenuated after excluding patients who died of or were diagnosed with cancer during the first 2 years of follow-up. CONCLUSIONS The study suggests an inverse association of HDL-C with cancer risk among men and women with type 2 diabetes, whereas the effect of HDL-C was partially mediated by reverse causation.
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Affiliation(s)
- Wenhui Zhao
- Pennington Biomedical Research Center, Baton Rouge, LA Department of Endocrinology, China Japan Friendship Hospital, Beijing, China
| | - Jing Guan
- Pennington Biomedical Research Center, Baton Rouge, LA Beijing University of Traditional Chinese Medicine, Beijing, China
| | | | - Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Xiaocheng Wu
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Li W, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G. Body mass index and the risk of all-cause mortality among patients with type 2 diabetes mellitus. Circulation 2014; 130:2143-51. [PMID: 25378546 DOI: 10.1161/circulationaha.114.009098] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several prospective studies have evaluated the association between body mass index (BMI) and death risk among patients with diabetes mellitus; however, the results have been inconsistent. METHODS AND RESULTS We performed a prospective cohort study of 19 478 black and 15 354 white patients with type 2 diabetes mellitus. Cox proportional hazards regression models were used to estimate the association of different levels of BMI stratification with all-cause mortality. During a mean follow-up of 8.7 years, 4042 deaths were identified. The multivariable-adjusted (age, sex, smoking, income, and type of insurance) hazard ratios for all-cause mortality associated with BMI levels (18.5-22.9, 23-24.9, 25-29.9, 30-34.9 [reference group], 35-39.9, and ≥40 kg/m(2)) at baseline were 2.12 (95% confidence interval [CI], 1.80-2.49), 1.74 (95% CI, 1.46-2.07), 1.23 (95% CI, 1.08-1.41), 1.00, 1.19 (95% CI, 1.03-1.39), and 1.23 (95% CI, 1.05-1.43) for blacks and 1.70 (95% CI, 1.42-2.04), 1.51 (95% CI, 1.27-1.80), 1.07 (95% CI, 0.94-1.21), 1.00, 1.07 (95% CI, 0.93-1.23), and 1.20 (95% CI, 1.05-1.38) for whites, respectively. When stratified by age, smoking status, patient type, or the use of antidiabetic drugs, a U-shaped association was still present. When BMI was included in the Cox model as a time-dependent variable, the U-shaped association of BMI with all-cause mortality risk did not change. CONCLUSIONS The present study indicated a U-shaped association of BMI with all-cause mortality risk among black and white patients with type 2 diabetes mellitus. A significantly increased risk of all-cause mortality was observed among blacks with BMI <30 kg/m(2) and ≥35 kg/m(2) and among whites with BMI <25 kg/m(2) and ≥40 kg/m(2) compared with patients with BMI of 30 to 34.9 kg/m(2).
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Affiliation(s)
- Wenhui Zhao
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Peter T Katzmarzyk
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Ronald Horswell
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Yujie Wang
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Weiqin Li
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Jolene Johnson
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Steven B Heymsfield
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - William T Cefalu
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Donna H Ryan
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.)
| | - Gang Hu
- From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
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Wang Y, Katzmarzyk PT, Horswell R, Zhao W, Li W, Johnson J, Ryan DH, Hu G. Racial disparities in cardiovascular risk factor control in an underinsured population with Type 2 diabetes. Diabet Med 2014; 31:1230-6. [PMID: 24750373 PMCID: PMC4167915 DOI: 10.1111/dme.12470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 01/30/2014] [Accepted: 04/10/2014] [Indexed: 01/14/2023]
Abstract
AIM To investigate the race-specific trend in attainment of the American Diabetes Association cardiovascular risk factor control goals (HbA1c <53 mmol/mol (7.0%), blood pressure <130/80 mmHg and LDL cholesterol <2.6mmol/l) by patients with Type 2 diabetes. METHODS The study sample included 14 946 African-American and 12 758 white patients who were newly diagnosed with Type 2 diabetes between 2001 and 2009 in the Louisiana State University Hospital system. The race-specific percentages of patients' attainment of American Diabetes Association goals were calculated using the baseline and follow-up measurements of HbA1c , blood pressure, and LDL cholesterol levels. Logistic regression was used to test the difference between African-American and white patients. RESULTS The percentage of patients who met all three American Diabetes Association goals increased from 8.2% in 2001 to 10.2% in 2009 (increased by 24.4%) in this cohort. Compared with African-American patients, white patients had better attainment of the following American Diabetes Association goals: HbA1c (61.4 vs. 55.1%), blood pressure (25.8 vs. 20.4%), LDL cholesterol (40.1 vs. 37.7%) and all three goals (7.3 vs. 5.1%). African-American and white patients generally had a better cardiovascular disease risk factor profile during follow-up when we assessed attainment of the American Diabetes Association goals by means of HbA1c , blood pressure and LDL cholesterol. CONCLUSIONS During 2001-2009, the present low-income cohort of people with Type 2 diabetes generally experienced improved control of cardiovascular disease risk factors. White patients had better attainment of the American Diabetes Association cardiovascular risk factor control goals than their African-American counterparts.
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Affiliation(s)
- Y Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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11
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Zhao W, Katzmarzyk PT, Horswell R, Li W, Wang Y, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G. Blood pressure and heart failure risk among diabetic patients. Int J Cardiol 2014; 176:125-32. [PMID: 25037690 DOI: 10.1016/j.ijcard.2014.06.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Blood pressure (BP) control has been shown to reduce the risk of heart failure (HF) among diabetic patients; however, it is not known whether the lowest clinical BP achieved ultimately results in the lowest risk of HF in diabetic patients. METHODS We performed a prospective cohort study which included 17,181 African American and 12,446 white diabetic patients without established coronary heart disease and HF at diabetes diagnosis. Cox proportional hazards regression models were used to estimate the association of different levels of BP stratification with incident HF. RESULTS During a mean follow up of 6.5 years, 5,089 incident HF cases were identified. The multivariable-adjusted hazard ratios of HF associated with different levels of systolic/diastolic BP (<110/65, 110-119/65-69, 120-129/70-80, 130-139/80-90 [reference group], 140-159/90-100, and ≥ 160/100 mmHg) were 1.79 (95% confidence interval [CI] 1.53-2.11), 1.34 (95% CI 1.16-1.53), 1.02 (95% CI 0.92-1.13), 1.00, 1.04 (95% CI 0.95-1.12), and 1.26 (95% CI 1.16-1.37) using baseline BP measurements, and 2.63 (95% CI 2.02-3.41), 1.84 (95% CI 1.59-2.13), 1.25 (95% CI 1.14-1.37), 1.00, 1.11 (95% CI 1.03-1.19), and 1.32 (95% CI 1.20-1.44) using an updated mean value of BP during follow-up, respectively. The U-shaped association was confirmed in both patients who were and were not taking antihypertensive drugs, and in incident systolic HF (ejection fraction ≤ 40%) and incident HF with a preserved ejection fraction (ejection fraction >40%). CONCLUSIONS The current study suggests a U-shaped association between observed BP and the risk of HF among diabetic patients.
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Affiliation(s)
- Wenhui Zhao
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; China Japan Friendship Hospital, Beijing, China
| | | | | | - Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | | | - Donna H Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. Sex differences in the risk of stroke and HbA(1c) among diabetic patients. Diabetologia 2014; 57:918-26. [PMID: 24577725 PMCID: PMC4141535 DOI: 10.1007/s00125-014-3190-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/23/2014] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS Sex differences in macrovascular disease, especially in stroke, are observed across studies of epidemiology. We studied a large sample of patients with type 2 diabetes to better understand the relationship between glycaemic control and stroke risk. METHODS We prospectively investigated the sex-specific association between different levels of HbA(1c) and incident stroke risk among 10,876 male and 19,278 female patients with type 2 diabetes. RESULTS During a mean follow-up of 6.7 years, 2,949 incident cases of stroke were identified. The multivariable-adjusted HRs of stroke associated with different levels of HbA(1c) at baseline (HbA(1c) <6.0% [<42 mmol/mol], 6.0-6.9% [42-52 mmol/mol] [reference group], 7.0-7.9% [53-63 mmol/mol], 8.0-8.9% [64-74 mmol/mol], 9.0-9.9% [75-85 mmol/mol] and ≥10.0% [≥86 mmol/mol]) were 0.96 (95% CI 0.80, 1.14), 1.00, 1.04 (0.85, 1.28), 1.11 (0.89, 1.39), 1.10 (0.86, 1.41) and 1.22 (0.92, 1.35) (p for trend = 0.66) for men, and 1.03 (0.90, 1.18), 1.00, 1.09 (0.94, 1.26), 1.19 (1.00, 1.42), 1.32 (1.09, 1.59) and 1.42 (1.23, 1.65) (p for trend <0.001) for women, respectively. The graded association between HbA(1c) during follow-up and stroke risk was observed among women (p for trend = 0.066). When stratified by race, whether with or without glucose-lowering agents, this graded association of HbA(1c) with stroke was still present among women. When stratified by age, the adjusted HRs were significantly higher in women older than 55 years compared with younger women. CONCLUSIONS/INTERPRETATION The current study suggests a graded association between HbA1c and the risk of stroke among women with type 2 diabetes. Poor control of blood sugar has a stronger effect in diabetic women older than 55 years.
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Affiliation(s)
- Wenhui Zhao
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center
| | - Peter T. Katzmarzyk
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center
| | - Ronald Horswell
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center
| | - Yujie Wang
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center
| | | | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center
- G Hu, Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA, Tel: 225-763-3053, Fax: 225-763-3009,
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. HbA1c and coronary heart disease risk among diabetic patients. Diabetes Care 2014; 37:428-35. [PMID: 24130365 PMCID: PMC4179505 DOI: 10.2337/dc13-1525] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Clinical trials to date have not provided definitive evidence regarding the effects of glucose lowering with coronary heart disease (CHD) risk among diabetic patients. RESEARCH DESIGN AND METHODS We prospectively investigated the association of HbA1c at baseline and during follow-up with CHD risk among 17,510 African American and 12,592 white patients with type 2 diabetes. RESULTS During a mean follow-up of 6.0 years, 7,258 incident CHD cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of HbA1c at baseline (<6.0 [reference group], 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-9.9, 10.0-10.9, and ≥11.0%) were 1.00, 1.07 (95% CI 0.97-1.18), 1.16 (1.04-1.31), 1.15 (1.01-1.32), 1.26 (1.09-1.45), 1.27 (1.09-1.48), and 1.24 (1.10-1.40) (P trend = 0.002) for African Americans and 1.00, 1.04 (0.94-1.14), 1.15 (1.03-1.28), 1.29 (1.13-1.46), 1.41 (1.22-1.62), 1.34 (1.14-1.57), and 1.44 (1.26-1.65) (P trend <0.001) for white patients, respectively. The graded association of HbA1c during follow-up with CHD risk was observed among both African American and white diabetic patients (all P trend <0.001). Each one percentage increase of HbA1c was associated with a greater increase in CHD risk in white versus African American diabetic patients. When stratified by sex, age, smoking status, use of glucose-lowering agents, and income, this graded association of HbA1c with CHD was still present. CONCLUSIONS The current study in a low-income population suggests a graded positive association between HbA1c at baseline and during follow-up with the risk of CHD among both African American and white diabetic patients with low socioeconomic status.
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G. HbA1c and lower-extremity amputation risk in low-income patients with diabetes. Diabetes Care 2013; 36:3591-8. [PMID: 24062322 PMCID: PMC3816880 DOI: 10.2337/dc13-0437] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes confers a very high risk of lower-extremity amputation (LEA); however, few studies have assessed whether blood glucose control can reduce LEA risk among patients with diabetes, especially in practice settings where low-income patients predominate. RESEARCH DESIGN AND METHODS We performed a prospective cohort study (2000-2009) on patients with diabetes that included 19,808 African Americans and 15,560 whites. The cohort was followed though 31 May 2012. Cox proportional hazards regression models were used to estimate the association of HbA1c with LEA risk. RESULTS During a mean follow-up of 6.83 years, 578 LEA incident cases were identified. The multivariable-adjusted hazard ratios of LEA associated with different levels of HbA1c at baseline (<6.0% [reference group], 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-9.9, and ≥10.0%) were 1.00, 1.73 (95% CI 1.07-2.80), 1.65 (0.99-2.77), 1.96 (1.14-3.36), 3.02 (1.81-5.04), and 3.30 (2.10-5.20) (P trend <0.001) for African American patients with diabetes and 1.00, 1.16 (0.66-2.02), 2.28 (1.35-3.85), 2.38 (1.36-4.18), 2.99 (1.71-5.22), and 3.25 (1.98-5.33) (P trend <0.001) for white patients with diabetes, respectively. The graded positive association of HbA1c during follow-up with LEA risk was observed among both African American and white patients with diabetes (all P trend <0.001). With stratification by sex, age, smoking status, blood pressure, LDL cholesterol, BMI, use of glucose-lowering agents, and income, this graded association of HbA1c with LEA was still present. CONCLUSIONS The current study conducted in a low-income population suggests a graded association between HbA1c and the risk of LEA among both African American and white patients with type 2 diabetes.
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Li W, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G. Aggressive blood pressure control increases coronary heart disease risk among diabetic patients. Diabetes Care 2013; 36:3287-96. [PMID: 23690530 PMCID: PMC3781514 DOI: 10.2337/dc13-0189] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Blood pressure control can reduce the risk of coronary heart disease (CHD) among diabetic patients; however, it is not known whether the lowest risk of CHD is among diabetic patients with the lowest blood pressure level. RESEARCH DESIGN AND METHODS We performed a prospective cohort study (2000-2009) on diabetic patients including 17,536 African Americans and 12,618 whites. Cox proportional hazards regression models were used to estimate the association of blood pressure with CHD risk. RESULTS During a mean follow-up of 6.0 years, 7,260 CHD incident cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of systolic/diastolic blood pressure at baseline (<110/65, 110-119/65-69, 120-129/70-80, and 130-139/80-90 mmHg [reference group]; 140-159/90-100; and ≥160/100 mmHg) were 1.73, 1.16, 1.04, 1.00, 1.06, and 1.11 (P trend<0.001), respectively, for African American diabetic patients, and 1.60, 1.27, 1.08, 1.00, 0.95, and 0.99 (P trend<0.001) for white diabetic patients, respectively. A U-shaped association of isolated systolic and diastolic blood pressure at baseline as well as blood pressure during follow-up with CHD risk was observed among both African American and white diabetic patients (all Ptrend<0.001). The U-shaped association was present in the younger age-group (30-49 years), and this U-shaped association changed to an inverse association in the older age-group (≥60 years). CONCLUSIONS Our study suggests that there is a U-shaped or inverse association between blood pressure and the risk of CHD, and aggressive blood pressure control (blood pressure<120/70 mmHg) is associated with an increased risk of CHD among both African American and white patients with diabetes.
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Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Cefalu WT, Ryan DH, Hu G. Blood pressure and stroke risk among diabetic patients. J Clin Endocrinol Metab 2013; 98:3653-62. [PMID: 23714680 PMCID: PMC5393468 DOI: 10.1210/jc.2013-1757] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Blood pressure (BP) control can reduce the risk of stroke among diabetic patients; however, it is not known whether the lowest risk of stroke is among diabetic patients with the lowest BP level. OBJECTIVE Our objective was to investigate the race-specific association of different levels of BP with stroke risk among diabetic patients in the Louisiana State University Hospital-based longitudinal study. DESIGN, SETTING, AND PARTICIPANTS We prospectively investigated the race-specific association of different levels of BP at baseline and during an average of 6.7 years of follow-up with incident stroke risk among 17,536 African American and 12,618 white diabetic patients within the Louisiana State University Hospital System. MAIN OUTCOME MEASURE We evaluated incident stroke until May 31, 2012. RESULTS During follow-up, 2949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios of stroke associated with different levels of systolic/diastolic BP at baseline (<110/65, 110-119/65-69, 120-129/70-80 [reference group], 130-139/80-90, 140-159/90-100, and ≥160/100 mm Hg) were 1.88 (95% confidence interval = 1.38-2.56), 1.05 (0.80-1.42), 1.00, 1.05 (0.86-1.27), 1.12 (0.94-1.34), and 1.47 (1.24-1.75) for African American diabetic patients and 1.42 (1.06-1.91), 1.22 (0.95-1.57), 1.00, 0.88 (0.72-1.06), 1.02 (0.86-1.21), and 1.28 (1.07-1.54) for white diabetic patients, respectively. A U-shaped association of isolated systolic or diastolic BP at baseline and during follow-up with stroke risk was observed among both African American and white diabetic patients. The U-shaped association was confirmed in both patients who were and were not taking antihypertensive drugs. CONCLUSIONS The current study suggests a U-shaped association between BP and the risk of stroke. Aggressive BP control (<110/65 mm Hg) and high BP (≥160/100 mm Hg) are associated with an increased risk of stroke among both African American and white patients with type 2 diabetes.
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Affiliation(s)
- Wenhui Zhao
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, Louisiana 70808, USA
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