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Ma XN, Shi MF, Wang SI, Feng W, Chen SL, Zhong XQ, Liu QP, Cheng-Chung Wei J, Lin CS, Xu Q. Risk of dyslipidemia and major adverse cardiac events with tofacitinib versus adalimumab in rheumatoid arthritis: a real-world cohort study from 7580 patients. Front Pharmacol 2024; 15:1370661. [PMID: 38881871 PMCID: PMC11177090 DOI: 10.3389/fphar.2024.1370661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To compare the effects of tofacitinib and adalimumab on the risk of adverse lipidaemia outcomes in patients with newly diagnosed rheumatoid arthritis (RA). Methods Data of adult patients newly diagnosed with RA who were treated with tofacitinib or adalimumab at least twice during a 3-year period from 1 January 2018 to 31 December 2020, were enrolled in the TriNetX US Collaborative Network. Patient demographics, comorbidities, medications, and laboratory data were matched by propensity score at baseline. Outcome measurements include incidental risk of dyslipidemia, major adverse cardiac events (MACE) and all-cause mortality. Results A total of 7,580 newly diagnosed patients with RA (1998 receiving tofacitinib, 5,582 receiving adalimumab) were screened. After propensity score matching, the risk of dyslipidaemia outcomes were higher in the tofacitinib cohort, compared with adalimumab cohort (hazard ratio [HR] with 95% confidence interval [CI], 1.250 [1.076-1.453]). However, there is no statistically significant differences between two cohorts on MACE (HR, 0.995 [0.760-1.303]) and all-cause mortality (HR, 1.402 [0.887-2.215]). Conclusion Tofacitinib use in patients with RA may increase the risk of dyslipidaemia to some extent compared to adalimumab. However, there is no differences on MACE and all-cause mortality.
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Affiliation(s)
- Xiao-Na Ma
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mei-Feng Shi
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei Feng
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shu-Lin Chen
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Qin Zhong
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Ping Liu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Office of Research and Development, Asia University, Taichung, Taiwan
| | - Chang-Song Lin
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Xu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Sur NB, Kozberg M, Desvigne-Nickens P, Silversides C, Bushnell C. Improving Stroke Risk Factor Management Focusing on Health Disparities and Knowledge Gaps. Stroke 2024; 55:248-258. [PMID: 38134258 DOI: 10.1161/strokeaha.122.040449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Stroke is a leading cause of death and disability in the United States and worldwide, necessitating comprehensive efforts to optimize stroke risk factor management. Health disparities in stroke incidence, prevalence, and risk factor management persist among various race/ethnic, geographic, and socioeconomic populations and negatively impact stroke outcomes. This review highlights existing literature and guidelines for stroke risk factor management, emphasizing health disparities among certain populations. Moreover, stroke risk factors for special groups, including the young, the very elderly, and pregnant/peripartum women are outlined. Strategies for stroke risk factor improvement at every level of the health care system are discussed, from the individual patient to providers, health care systems, and policymakers. Improving stroke risk factor management in the context of the social determinants of health, and with the goal of eliminating inequities and disparities in stroke prevention strategies, are critical steps to reducing the burden of stroke and equitably improving public health.
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Affiliation(s)
- Nicole B Sur
- Department of Neurology, University of Miami Miller School of Medicine, FL (N.B.S.)
| | - Mariel Kozberg
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (M.K.)
| | | | | | - Cheryl Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC (C.B.)
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3
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Chen Y, Du J, Zhou N, Song Y, Wang W, Hong X. Prevalence, awareness, treatment and control of dyslipidaemia and their determinants: results from a population-based survey of 60 283 residents in eastern China. BMJ Open 2023; 13:e075860. [PMID: 38128931 DOI: 10.1136/bmjopen-2023-075860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To investigate the prevalence, awareness, treatment and control of dyslipidaemia and its associated factors in eastern China. DESIGN Cross-sectional study. SETTING Data were collected from the 2017 Nanjing Chronic Disease and Risk Factor Surveillance. PARTICIPANTS This study included 60 283 participants aged ≥18 years. OUTCOME MEASURES Prevalence of dyslipidaemia was defined as self-reported history of dyslipidaemia and/or the use of lipid-lowering medication, and/or meeting at least one of the following during on-site investigation: total cholesterol ≥6.2 mmol/L, triglyceride ≥2.3 mmol/L, low-density lipoprotein cholesterol ≥4.1 mmol/L and high-density lipoprotein cholesterol <1.0 mmol/L. Dyslipidaemia awareness was defined as the proportion of patients with dyslipidaemia who explicitly indicate their awareness of having a diagnosis of dyslipidaemia. Treatment was based on medication use among individuals with dyslipidaemia. Control was defined as having dyslipidaemia, receiving treatment and achieving serum lipid control to the standard level. ANALYSIS Complex weighting was used to calculate weighted prevalence. A two-level logistic regression model determined the influencing factors for dyslipidaemia prevalence, awareness, treatment and control. RESULTS The crude prevalence rate of dyslipidaemia was 28.4% (17 093 of 60 283). Among 17 093 patients with dyslipidaemia, the crude rates of awareness, treatment and control were 40.0% (n=6830), 27.5% (n=4695) and 21.9% (n=3736), respectively. The corresponding weighted prevalence rates were 29.8%, 41.6%, 28.9% and 22.9%. Older age (OR 2.03, 95% CI 1.82 to 2.23), urban residence (1.24, 1.19 to 1.31), higher education level (1.31, 1.21 to 1.42), current smoking (1.22, 1.15 to 1.29), alcohol consumption (1.20, 1.14 to 1.26), obesity (2.13, 1.99 to 2.29), history of hypertension (1.64, 1.56 to 1.71) and diabetes (1.92, 1.80 to 2.04) were identified as independent risk factors for dyslipidaemia (all p<0.001). Participants who were older, female, living in urban areas, had higher education levels, did not smoke or drink alcohol, had central obesity, had hypertension or had diabetes were more likely to be aware of their dyslipidaemia conditions, receive treatment and achieve serum lipid control to a standard level than their comparators (all p<0.05). CONCLUSIONS The prevalence of dyslipidaemia is relatively high in eastern China; however, awareness, treatment and control levels are relatively low.
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Affiliation(s)
- Yijia Chen
- Department of Chronic and Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Jinling Du
- Department of Chronic and Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China
| | - Nan Zhou
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Yingqian Song
- Department of Chronic and Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China
| | - Weiwei Wang
- Department of Chronic and Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Xin Hong
- Department of Chronic and Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China
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Ogungbe O, Grant JK, Ayoola AS, Bansah E, Miller HN, Plante TB, Sheikhattari P, Commodore-Mensah Y, Turkson-Ocran RAN, Juraschek SP, Martin SS, Lin M, Himmelfarb CR, Michos ED. Strategies for Improving Enrollment of Diverse Populations with a Focus on Lipid-Lowering Clinical Trials. Curr Cardiol Rep 2023; 25:1189-1210. [PMID: 37787858 DOI: 10.1007/s11886-023-01942-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. RECENT FINDINGS Barriers to participation in trials occur at the study, participant, health system, sponsor, and policy level, requiring a multilevel approach to effectively increase participation of under-represented groups in research. Increasing the representation of marginalized and under-represented groups in leadership positions in clinical trials can ensure that their perspectives and experiences are considered. Trial design should prioritize patient- and community-indicated needs. Women and individuals from racially/ethnically diverse populations remain under-represented in lipid-lowering and other cardiovascular clinical trials relative to their disease burden in the population. This limits the generalizability of trial results to the broader population in clinical practice. Collaboration between community stakeholders, researchers, and community members can facilitate shared learning about trials and build trust.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jelani K Grant
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Eyram Bansah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hailey N Miller
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Payam Sheikhattari
- School of Community Health & Policy, Morgan State University, Baltimore, MD, 21251, USA
- Prevention Sciences Research Center, Morgan State University, Baltimore, MD, 21251, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
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Rivera-Íñiguez I, González-Becerra K, Ramos-Lopez O, Peréz-Beltrán YE, Chagüén-Hernández MS, Martínez-López E, Mendivil EJ. Lipid-Related Genetic Variants for Personalized Dietary Interventions: A Systematic Review. Mol Nutr Food Res 2023; 67:e2200675. [PMID: 37186438 DOI: 10.1002/mnfr.202200675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/26/2023] [Indexed: 05/17/2023]
Abstract
Dyslipidemias are known risk factors for chronic diseases. Precision nutrition interventions are designed according to characteristics, such as diet, phenotype, and genotype. This systematic review aims to define a panel of genetic variants associated with lipid abnormalities that could be later used in nutrigenetic intervention studies. A systematic review is conducted following the PRISMA-P. Studies published from January 2010 to December 2020 in English language and humans are included from PubMed and ScienceDirect databases. Articles that demonstrate a strong association between polymorphisms (single nucleotide variation) of genes involved in lipid metabolism and increased risk for dyslipidemia are included. A total of 3031 articles are screened, but only 51 articles fulfill the inclusion criteria. The genes included are FABP2, MTTP related to CM synthesis and secretion; LPL, LIPC involved in triglyceride hydrolysis; CETP, APOA1, LCAT, ABCA1, and APOA5 related to lipoprotein metabolism, and APOE, LDLR, SCARB1, APOC3 involved in lipid clearance. In this systematic review, genetic variants related to chylomicron synthesis, triglyceride hydrolysis, lipoprotein metabolism, and lipid clearance demonstrate a strong association with lipid abnormalities, which can be used to design precision nutrition interventions that may help to prevent and treat dyslipidemia effectively.
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Affiliation(s)
- Ingrid Rivera-Íñiguez
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Karina González-Becerra
- Departamento de Ciencias Médicas y de la Vida, Centro Universitario de la Ciénega, Instituto de Investigación en Genética Molecular, Universidad de Guadalajara, Ocotlán, Jalisco, 47820, México
| | - Omar Ramos-Lopez
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, 22390, México
| | - Yolanda E Peréz-Beltrán
- Laboratorio Integral de Investigación en Alimentos, Instituto Tecnológico de Tepic/Instituto Nacional de México, Tepic, Nayarit, 63175, México
| | - Marian S Chagüén-Hernández
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Edgar J Mendivil
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, 01219, México
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Gitajn IL, Werth P, Fernandes E, Sprague S, O'Hara NN, Bzovsky S, Marchand LS, Patterson JT, Lee C, Slobogean GP. Association of Patient-Level and Hospital-Level Factors With Timely Fracture Care by Race. JAMA Netw Open 2022; 5:e2244357. [PMID: 36449289 PMCID: PMC9713603 DOI: 10.1001/jamanetworkopen.2022.44357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Racial disparities in treatment benchmarks have been documented among older patients with hip fractures. However, these studies were limited to patient-level evaluations. OBJECTIVE To assess whether disparities in meeting fracture care time-to-surgery benchmarks exist at the patient level or at the hospital or institutional level using high-quality multicenter prospectively collected data; the study hypothesis was that disparities at the hospital-level reflecting structural health systems issues would be detected. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a secondary analysis of prospectively collected data in the PREP-IT (Program of Randomized trials to Evaluate Preoperative antiseptic skin solutions in orthopaedic Trauma) program from 23 sites throughout North America. The PREP-IT trials enrolled patients from 2018 to 2021, and patients were followed for 1-year. All patients with hip and femur fractures enrolled in the PREP-IT program were included in analysis. Data were analyzed April to September 2022. EXPOSURES Patient-level and hospital-level race, ethnicity, and insurance status. MAIN OUTCOMES AND MEASURES Primary outcome measure was time to surgery based on 24-hour time-to-surgery benchmarks. Multilevel multivariate regression models were used to evaluate the association of race, ethnicity, and insurance status with time to surgery. The reported odds ratios (ORs) were per 10% change in insurance coverage or racial composition at the hospital level. RESULTS A total of 2565 patients with a mean (SD) age of 64.5 (20.4) years (1129 [44.0%] men; mean [SD] body mass index, 27.3 [14.9]; 83 [3.2%] Asian, 343 [13.4%] Black, 2112 [82.3%] White, 28 [1.1%] other) were included in analysis. Of these patients, 834 (32.5%) were employed and 2367 (92.2%) had insurance; 1015 (39.6%) had sustained a femur fracture, with a mean (SD) injury severity score of 10.4 (5.8). Five hundred ninety-six patients (23.2%) did not meet the 24-hour time-to-operating-room benchmark. After controlling for patient-level characteristics, there was an independent association between missing the 24-hour benchmark and hospital population insurance coverage (OR, 0.94; 95% CI, 0.89-0.98; P = .005) and the interaction term between hospital population insurance coverage and racial composition (OR, 1.03; 95% CI, 1.01-1.05; P = .03). There was no association between patient race and delay beyond 24-hour benchmarks (OR, 0.96; 95% CI, 0.72-1.29; P = .79). CONCLUSIONS AND RELEVANCE In this cohort study, patients who sought care from an institution with a greater proportion of patients with racial or ethnic minority status or who were uninsured were more likely to experience delays greater than the 24-hour benchmarks regardless of the individual patient race; institutions that treat a less diverse patient population appeared to be more resilient to the mix of insurance status in their patient population and were more likely to meet time-to-surgery benchmarks, regardless of patient insurance status or population-based insurance mix. While it is unsurprising that increased delays were associated with underfunded institutions, the association between institutional-level racial disparity and surgical delays implies structural health systems bias.
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Affiliation(s)
| | - Paul Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Hong N, Lin Y, Ye Z, Yang C, Huang Y, Duan Q, Xie S. The relationship between dyslipidemia and inflammation among adults in east coast China: A cross-sectional study. Front Immunol 2022; 13:937201. [PMID: 36032093 PMCID: PMC9403313 DOI: 10.3389/fimmu.2022.937201] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Dyslipidemia is one of the major public health problems in China. It is characterized by multisystem dysregulation and inflammation, and oxidant/antioxidant balance has been suggested as an important factor for its initiation and progression. The objective of this study was to determine the relationship between prevalence of dyslipidemia and measured changes in the levels of proinflammatory cytokines (IL-6, TNF-a, and MCP-1), thiobarbituric acid-reactant substances (TBARS), and serum total antioxidant capacity (TAC) in serum samples. Study design A cross-sectional survey with a purposive sampling of 2,631 enrolled participants (age 18–85 years) was performed using the adult population of long-term residents of the municipality of east coast China in Fujian province between the years 2017 and 2019. Information on general health status, dyslipidemia prevalence, and selected mediators of inflammation was collected through a two-stage probability sampling design according to socioeconomic level, sex, and age. Methods The lipid profile was conducted by measuring the levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) with an autoanalyzer. Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria, and patients with it were identified by means of a computerized database. Serum parameters including IL-6/TNF-a/MCP-1, TBARS, and TAC were measured in three consecutive years. Familial history, education level, risk factors, etc. were determined. The association between dyslipidemia and serum parameters was explored using multivariable logistic regression models. Sociodemographic, age, and risk factors were also investigated among all participants. Results The mean prevalence of various dyslipidemia in the population at baseline (2017) was as follows: dyslipidemias, 28.50%; hypercholesterolemia, 26.33%; high LDL-C, 26.10%; low HDL-C, 24.44%; and hypertriglyceridemia, 27.77%. A significant effect of aging was found among all male and female participants. The mean levels of serum Il-6/TNF-a/MCP-1 were significantly higher in all the types of dyslipidemia among male participants. Female participants with all types of dyslipidemia but low HDL-C showed an elevation of IL-6 and MCP-1 levels, and those with dyslipidemias and hypercholesterolemia presented higher levels of TNF-a compared to the normal participants. The oxidative stress marker TBARS increased among all types of dyslipidemia except hypertriglyceridemia. All participants with different types of dyslipidemia had a lower total antioxidant capacity. Correlation analysis showed that cytokines and TBARS were positively associated with age, obesity, and diabetes mellitus, but not sex, sedentary leisure lifestyle, hypertension, and CVD/CHD history. The activity of TAC was negatively associated with the above parameters. Conclusions The correlation between the prevalence of dyslipidemia and the modification of inflammation status was statistically significant. The levels of proinflammatory cytokines, oxidative stress, and antioxidant capacity in serum may reflect the severity of the lipid abnormalities. These promising results further warrant a thorough medical screening in enhanced anti-inflammatory and reduced oxidative stress to better diagnose and comprehensively treat dyslipidemia at an early stage.
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Affiliation(s)
- Najiao Hong
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
- *Correspondence: Najiao Hong, ; Sixin Xie,
| | - Yongjun Lin
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
| | - Zhirong Ye
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
| | - Chunbaixue Yang
- Department of Mathematics, Virginia Tech, Blacksburg, VA, United States
| | - Yulong Huang
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
| | - Qi Duan
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
| | - Sixin Xie
- Department of General Medicine, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, China
- *Correspondence: Najiao Hong, ; Sixin Xie,
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8
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Friedman MR, Liu Q, Meanley S, Haberlen SA, Brown AL, Turan B, Turan JM, Brennan-Ing M, Stosor V, Mimiaga MJ, Ware D, Egan JE, Plankey MW. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health 2022; 112:S452-S462. [PMID: 35763737 PMCID: PMC9241468 DOI: 10.2105/ajph.2022.306735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
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Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Qimin Liu
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Meanley
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Sabina A Haberlen
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Andre L Brown
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Bulent Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Janet M Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Mark Brennan-Ing
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Valentina Stosor
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J Mimiaga
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - James E Egan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Michael W Plankey
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
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9
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Headen AC, Siaw-Asamoah A, Julien HM. Race and Modifiable Factors Influencing Cardiovascular Disease. Med Clin North Am 2022; 106:401-409. [PMID: 35227439 DOI: 10.1016/j.mcna.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A modern approach to mitigating the impact of cardiovascular disease on Americans demands not only an understanding of modifiable conditions that contribute to its development but also a greater appreciation of the heterogeneous distribution of these conditions based on race. As race is not a biological construct, further research is needed to fully elucidate the mechanisms that contribute to these differences. The consequences of the differential impact of modifiable risk factors on cardiovascular disease outcomes among black Americans compared with white Americans cannot be understated.
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Affiliation(s)
| | - Andrew Siaw-Asamoah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Howard M Julien
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center; Penn Cardiovascular Center for Health Equity and Social Justice.
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10
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Regional Implicit Bias Does Not Account for Racial Disparity in Total Joint Arthroplasty Utilization. J Arthroplasty 2021; 36:3845-3849. [PMID: 34479764 DOI: 10.1016/j.arth.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial disparities surrounding the utilization of total hip and total knee arthroplasty (THA, TKA) are well documented. The Implicit Association Test (IAT) is a validated tool used to measure implicit and explicit bias. The purpose of this study is to evaluate if variations in IAT scores by geographical region in the United States (US) correspond with regional variations in THA and TKA utilization by blacks compared to whites. METHODS Data from the US Census and National Inpatient Sample from 2012 to 2014 were used to calculate THA and TKA utilization rates among Medicare-aged blacks and whites. Data were aggregated by US Census Bureau Division. Regional implicit bias was assessed by calculating a weighted average of IAT scores for each division. RESULTS Across all geographic regions and years, the surveyed population demonstrated an implicit bias favoring whites over blacks. The population adjusted ratio of white-to-black utilization of THA and TKA by geographic division varied between 0.86-1.85 and 0.87-2.01, respectively. The difference in utilization between geographic divisions reached statistical significance (P < .001). No correlation was found between the IAT scores and race-specific utilization ratios among geographic divisions. CONCLUSION Implicit bias as measured by regional IAT did not reflect THA and TKA utilization disparities. The racial disparity in utilization of THA and TKA significantly varied between divisions. The observed disparity was greater in divisions with a relatively higher proportion of blacks. To the authors' knowledge, this is the first study to evaluate the impact of implicit bias on utilization of THA and TKA.
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11
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Diaz CL, Shah NS, Lloyd-Jones DM, Khan SS. State of the Nation's Cardiovascular Health and Targeting Health Equity in the United States: A Narrative Review. JAMA Cardiol 2021; 6:963-970. [PMID: 34009231 DOI: 10.1001/jamacardio.2021.1137] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Cardiovascular disease is the leading cause of death in the US. The burden of cardiovascular disease morbidity and mortality disproportionately affects racial/ethnic minority groups, who now compose almost 40% of the US population in aggregate. As part of the 2010 American Heart Association (AHA) Strategic Impact Goal, the AHA established 7 cardiovascular health (CVH) metrics (also known as Life's Simple 7) with the goal to improve the CVH of all individuals in the US by 20% by 2020. National estimates of CVH are important to track and monitor at the population level but may mask important differences across and within racial/ethnic minority groups. It is critical to understand how CVH may differ between racial/ethnic minority groups and consider how these differences in CVH may contribute to disparities in cardiovascular disease burden and overall longevity. Observations This narrative review summarizes the available literature on individual CVH metrics and composite CVH scores across different race/ethnic minority groups (specifically Hispanic/Latino, Asian, and non-Hispanic Black individuals) in the US. Disparities in CVH persist among racial/ethnic groups, but key gaps in knowledge exist, in part, owing to underrepresentation of these racial/ethnic groups in research or misrepresentation of CVH because of aggregation of race/ethnicity subgroups. A comprehensive, multilevel approach is needed to target health equity and should include (1) access to high-quality health care, (2) community-engaged approaches to adapt disruptive health care delivery innovations, (3) equitable economic investment in the social and built environment, and (4) increasing funding for research in racial/ethnic minority populations. Conclusions and Relevance Significant differences in CVH exist within racial/ethnic groups. Given the rapid growth of diverse, minority populations in the US, focused investigation is needed to identify strategies to optimize CVH. Opportunities exist to address inequities in CVH and to successfully achieve both the interim (AHA 2024) and longer-term (AHA 2030) Impact Goals in the coming years.
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Affiliation(s)
- Celso L Diaz
- Division of Cardiology, Department of Medicine, University of California, Los Angeles
| | - Nilay S Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Paraskevas KI, Mikhailidis DP, Baradaran H, Davies AH, Eckstein HH, Faggioli G, Fernandes E Fernandes J, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Kooi ME, Lanza G, Liapis CD, Loftus IM, Millon A, Nicolaides AN, Poredos P, Pini R, Ricco JB, Rundek T, Saba L, Spinelli F, Stilo F, Sultan S, Zeebregts CJ, Chaturvedi S. Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-212. INT ANGIOL 2021; 40:487-496. [PMID: 34313413 DOI: 10.23736/s0392-9590.21.04751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
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Affiliation(s)
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Alun H Davies
- Section of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna Alma Mater Studiorum, Policlinico S. Orsola Malpighi, Bologna, Italy
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Varese, Italy
| | | | - Ian M Loftus
- St. George's Vascular Institute, St. George's University London, London, UK
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew N Nicolaides
- Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna Alma Mater Studiorum, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy
| | - Francesco Spinelli
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA
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13
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Paraskevas KI, Mikhailidis DP, Baradaran H, Davies AH, Eckstein HH, Faggioli G, Fernandes JFE, Gupta A, Jezovnik MK, Kakkos SK, Katsiki N, Kooi ME, Lanza G, Liapis CD, Loftus IM, Millon A, Nicolaides AN, Poredos P, Pini R, Ricco JB, Rundek T, Saba L, Spinelli F, Stilo F, Sultan S, Zeebregts CJ, Chaturvedi S. Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action. J Stroke 2021; 23:202-212. [PMID: 34102755 PMCID: PMC8189852 DOI: 10.5853/jos.2020.04273] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/12/2021] [Indexed: 12/15/2022] Open
Abstract
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
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Affiliation(s)
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Alun H Davies
- Section of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Italy
| | | | - Ian M Loftus
- St. George's Vascular Institute, St. George's University London, London, UK
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, France
| | - Andrew N Nicolaides
- Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Francesco Spinelli
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA
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14
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Awareness, treatment, control, and determinants of dyslipidemia among adults in China. Sci Rep 2021; 11:10056. [PMID: 33980884 PMCID: PMC8115030 DOI: 10.1038/s41598-021-89401-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
Effective management of dyslipidemia is important. This study aimed to determine the awareness, treatment, control, and determinants of dyslipidemia in middle-aged and older Chinese adults in China. Using data from the 2015 China National Stroke Screening and Prevention Project (CNSSPP), a nationally representative sample of 135,403 Chinese adults aged 40 years or more were included in this analysis. Dyslipidemia was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults final report (NCEP-ATP III) and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Models were constructed to adjust for subjects’ characteristics with bivariate and multivariable logistic regression analyses. Overall, 51.1% of the subjects were women. Sixty-four percent were aware of their condition, of whom 18.9% received treatment, and of whom 7.2% had adequately controlled dyslipidemia. Dyslipidemia treatment was higher in men from rural areas than their urban counterparts. The multivariable logistic regression models revealed that women, urban residents, and general obesity were positively related to awareness. Women, married respondents, and current drinkers had higher odds of treatment. Age group, overweight, general obesity, urban residence, and women were independent determinants of control. Dyslipidemia awareness rate was moderately high, but treatment and control rates were low. Results can be used to develop policies and health promotion strategies with special focus on middle-aged and older adults.
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15
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Tajeu GS, Safford MM, Howard G, Howard VJ, Chen L, Long DL, Tanner RM, Muntner P. Black-White Differences in Cardiovascular Disease Mortality: A Prospective US Study, 2003-2017. Am J Public Health 2020; 110:696-703. [PMID: 32191519 PMCID: PMC7144446 DOI: 10.2105/ajph.2019.305543] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults.Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older.Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were women, 1549 CVD deaths occurred. Among participants younger than 65 years, the demographic-adjusted Black:White CVD mortality HR was 2.23 (95% confidence interval [CI] = 1.87, 2.65) and 1.21 (95% CI = 1.00, 1.47) after full adjustment. Among participants aged 65 years or older, the demographic-adjusted Black:White CVD mortality HR was 1.58 (95% CI = 1.39, 1.79) and 1.12 (95% CI = 0.97, 1.29) after full adjustment. When we used mediation analysis, socioeconomic status explained 21.2% (95% CI = 13.6%, 31.4%) and 38.0% (95% CI = 20.9%, 61.7%) of the Black:White CVD mortality risk difference among participants younger than 65 years and aged 65 years or older, respectively. CVD risk factors explained 56.6% (95% CI = 42.0%, 77.2%) and 41.3% (95% CI = 22.9%, 65.3%) of the Black:White CVD mortality difference for participants younger than 65 years and aged 65 years or older, respectively.Conclusions. The higher Black:White CVD mortality risk is primarily explained by racial differences in socioeconomic status and CVD risk factors.
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Affiliation(s)
- Gabriel S Tajeu
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Monika M Safford
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - George Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Virginia J Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Ligong Chen
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - D Leann Long
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Rikki M Tanner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Paul Muntner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
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16
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Ellis SG, Cho L, Raymond R, Nair R, Simpfendorfer C, Tuzcu M, Bajzer C, Lincoff AM, Kapadia S. Comparison of Long-Term Clinical Outcomes After Drug-Eluting Stenting in Blacks-vs-Whites. Am J Cardiol 2019; 124:1179-1185. [PMID: 31439280 DOI: 10.1016/j.amjcard.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
Patients of different racial backgrounds may have socioeconomic, cultural, or genetic differences that impact outcomes after percutaneous coronary intervention (PCI). There are limited data beyond 2 to 3 years for Blacks to inform discussions and perhaps improve outcomes. We studied consecutive limus-stent treated patients, having their first PCI at our institution January 2003 to March 2010 in 2 cohorts; Cohort 1: standard 3-year follow-up (n = 3,782, 12.4% Blacks) and Cohort 2: from nearby zip codes with intended detailed follow-up through 8 to 13 years (n = 616, 31.8% Blacks). The primary outcomes of interest were mortality and death/MI/revascularization (DMIR) (Cohort 1) or major adverse cardiac events (cardiac DMIR) (Cohort 2). In all cohorts, Blacks had a higher prevalence of many risk factors. In Cohort 1, 3-year mortalities were 14.6% and 9.6% (p = 0.001) and DMIR were 32.1% and 25.0% (p = 0.001), for Blacks and Whites, respectively. In Cohort 2, over 9.5 ± 2.0 years, treatment intensity was as high or higher for Blacks, but they continued to have higher low-density lipoprotein-cholesterol and blood pressure values. Major adverse cardiac events and mortality at 10 years were higher for Blacks (59.0% vs 48.1%, p = 0.024 and 44.3% vs 23.0%, p < 0.001). Differences in outcomes, except 10 year mortality, were not significantly different after adjustment for baseline characteristics. Blacks have a higher risk profile at the time of PCI and worse long-term outcomes after drug-eluting stent, most of which is explained by baseline differences.
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Affiliation(s)
- Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Leslie Cho
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Conrad Simpfendorfer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Bajzer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abraham Michael Lincoff
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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17
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Brown EA, Ward RC, Weeda E, Taber DJ, Axon RN, Gebregziabher M. Racial-Geographic Disparity in Lipid Management in Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study. Health Equity 2019; 3:472-479. [PMID: 31576377 PMCID: PMC6767165 DOI: 10.1089/heq.2019.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: The prevalence of diabetes in U.S. veterans (20.5%) is nearly three times that of the general population. Minority veterans have higher rates of diabetes compared with their counterparts and urban/rural residence is also associated with uncontrolled cholesterol. However, the interplay between urban/rural residence and race/ethnicity on cholesterol control is unclear. Methods: Veterans Health Administration Corporate Data Warehouse and Centers for Medicare and Medicaid data were used to create unique dataset and perform longitudinal study of veterans with type 2 diabetes from 2006 to 2016. Logistic regression was used to model the association between low-density lipoprotein (LDL) control and the primary exposures (race/ethnicity and location of residence) after adjusting for all measured covariates, including the interaction between location of residence and race/ethnicity. Results: There was a significant interaction between race/ethnicity and rural residence. Rural non-Hispanic Black (NHB) veterans had higher odds for LDL >100 mg/dL (odds ratio [OR]=1.70, 95% confidence interval [CI] 1.50–1.60) and for LDL >70 mg/dL (OR=1.59, 95% CI 1.53–1.64) compared with urban non-Hispanic White (NHW) veterans. Similarly, compared with urban NHW, urban NHB veterans had higher odds of LDL >100 mg/dL (OR=1.45, 95% CI 1.43–1.47) and LDL >70 mg/dL (OR=1.36, 95% CI 1.34–1.38). Conclusion: This study highlights health disparities for veterans with type 2 diabetes. Future research is needed to evaluate interventions for mitigating these disparities in cholesterol management among veterans with diabetes.
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Affiliation(s)
- Elizabeth A Brown
- Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Ralph C Ward
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Erin Weeda
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.,Department of SCCP Clinical Pharmacy and Outcome Sciences-MUSC Campus, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
| | - David J Taber
- Department of SCCP Clinical Pharmacy and Outcome Sciences-MUSC Campus, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery and College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Robert Neal Axon
- Department of Surgery and College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
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18
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Benetos A, Aviv A. Ancestry, Telomere Length, and Atherosclerosis Risk. ACTA ACUST UNITED AC 2019; 10:CIRCGENETICS.117.001718. [PMID: 28615296 DOI: 10.1161/circgenetics.117.001718] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Athanase Benetos
- From the Département de Médecine Gériatrique, CHRU de Nancy, The Institut national de la santé et de la recherche médicale, Université de Lorraine, France (A.B.); and Center of Human Development and Aging, New Jersey Medical School, Rutgers University, Newark (A.A.).
| | - Abraham Aviv
- From the Département de Médecine Gériatrique, CHRU de Nancy, The Institut national de la santé et de la recherche médicale, Université de Lorraine, France (A.B.); and Center of Human Development and Aging, New Jersey Medical School, Rutgers University, Newark (A.A.)
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19
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Vatcheva KP, Aparicio V, Araya A, Gonzalez E, Laing ST. Statin Prescription for Patients With Atherosclerotic Cardiovascular Disease from National Survey Data. Am J Cardiol 2019; 124:1-7. [PMID: 31029413 DOI: 10.1016/j.amjcard.2019.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
Despite strong evidence for the use of statins for patients with atherosclerotic cardiovascular disease (ASCVD), statin prescription is still suboptimal. We aimed to determine the rates and factors that influence statin prescription using national survey data. This is a cross-sectional retrospective study on 8,468 patients with clinical ASCVD who were drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from years 2011 to 2015. Survey-weighted analysis was conducted to estimate weighted prevalence and odds ratios for statin prescription. There was a significant increase in statin prescription from the years 2011 to 2015. Nevertheless, only 52% of ASCVD patients (55.4% in coronary heart disease and 37.7% in noncoronary heart disease) were prescribed a statin. Based on multivariable regression analysis, after adjusting for covariates, males had 1.28 (1.06, 1.55) higher odds of statin prescription, in coronary heart disease patients only. In the overall study population, Black n on-Hispanics had 31% lower odds of statin prescription compared with White non-Hispanics, and patients seen only by a healthcare provider other than a physician were 80% less likely to have a statin prescribed to them. In conclusion, the disparity in statin prescription in patients with ASCVD exists across minority groups, and our findings underscore existing variations in healthcare delivery.
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Affiliation(s)
- Kristina P Vatcheva
- School of Mathematical and Statistical Science, The University of Texas at Rio Grande Valley, Brownsville, Texas.
| | - Vicente Aparicio
- Cooperative Pharmacy Program, College of Health Professions, The University of Texas at Rio Grande Valley, Edinburg, Texas
| | - Ayesha Araya
- Cooperative Pharmacy Program, College of Health Professions, The University of Texas at Rio Grande Valley, Edinburg, Texas; College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Eduardo Gonzalez
- School of Mathematical and Statistical Science, The University of Texas at Rio Grande Valley, Brownsville, Texas
| | - Susan T Laing
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center-Houston, Houston, Texas
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20
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Zhao X, Geng X, Srinivasasainagendra V, Chaudhary N, Judd S, Wadley V, Gutiérrez OM, Wang H, Lange EM, Lange LA, Woo D, Unverzagt FW, Safford M, Cushman M, Limdi N, Quarells R, Arnett DK, Irvin MR, Zhi D. A PheWAS study of a large observational epidemiological cohort of African Americans from the REGARDS study. BMC Med Genomics 2019; 12:26. [PMID: 30704471 PMCID: PMC6357353 DOI: 10.1186/s12920-018-0462-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cardiovascular disease, diabetes, and kidney disease are among the leading causes of death and disability worldwide. However, knowledge of genetic determinants of those diseases in African Americans remains limited. RESULTS In our study, associations between 4956 GWAS catalog reported SNPs and 67 traits were examined among 7726 African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, which is focused on identifying factors that increase stroke risk. The prevalent and incident phenotypes studied included inflammation, kidney traits, cardiovascular traits and cognition. Our results validated 29 known associations, of which eight associations were reported for the first time in African Americans. CONCLUSION Our cross-racial validation of GWAS findings provide additional evidence for the important roles of these loci in the disease process and may help identify genes especially important for future functional validation.
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Affiliation(s)
- Xueyan Zhao
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Xin Geng
- BGI-Shenzhen, Shenzhen, 518083 China
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | | | - Ninad Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Virginia Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Orlando M. Gutiérrez
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Henry Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Ethan M. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Leslie A. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Frederick W. Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Monika Safford
- Division of General Internal Medicine, Weill Cornell Medical College, Cornell University, New York, NY 10065 USA
| | - Mary Cushman
- Department of Medicine and Pathology, Larner College of Medicine at the University of Vermont, Burlington, VT 05405 USA
| | - Nita Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310 USA
| | - Donna K. Arnett
- College of Public Health, University of Kentucky, Lexington, KY 40506 USA
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Degui Zhi
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
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21
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Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 679] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
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22
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Saadi A, Himmelstein DU, Woolhandler S, Mejia NI. Racial disparities in neurologic health care access and utilization in the United States. Neurology 2017; 88:2268-2275. [PMID: 28515272 DOI: 10.1212/wnl.0000000000004025] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/22/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States. METHODS We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy). To assess disparities in neurologic care utilization, we performed logistic regression analyses of outpatient department neurologic care visit rates and expenditures for each racial ethnic group controlling for age, sex, health status, socioeconomic characteristics, and geographic region of care. RESULTS Of the 279,103 MEPS respondents, 16,936 (6%) self-reported a neurologic condition; 5,890 (2%) received a total of 13,685 outpatient neurology visits. Black participants were nearly 30% less likely to see an outpatient neurologist (odds ratio [OR] 0.72, confidence interval [CI] 0.64-0.81) relative to their white counterparts, even after adjustment for demographic, insurance, and health status differences. Hispanic participants were 40% less likely to see an outpatient neurologist (OR 0.61, CI 0.54-0.69). Among participants with known neurologic conditions, blacks were more likely to be cared for in the emergency department, to have more hospital stays, and to have higher per capita inpatient expenditures than their white counterparts. CONCLUSIONS Our findings highlight racial and ethnic inequalities in the utilization of neurologic care in the United States.
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Affiliation(s)
- Altaf Saadi
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston.
| | - David U Himmelstein
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
| | - Steffie Woolhandler
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
| | - Nicte I Mejia
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
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23
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Gamboa CM, Colantonio LD, Brown TM, Carson AP, Safford MM. Race-Sex Differences in Statin Use and Low-Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc 2017; 6:JAHA.116.004264. [PMID: 28490523 PMCID: PMC5524054 DOI: 10.1161/jaha.116.004264] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Statin therapy is a cornerstone of cardiovascular disease risk reduction for people with diabetes mellitus. Past reports have shown race‐sex differences in statin use in general populations, but statin patterns by race and sex in those with diabetes mellitus have not been thoroughly studied. Methods and Results Our sample of 4288 adults ≥45 years of age with diagnosed diabetes mellitus who had low‐density lipoprotein cholesterol (LDL‐C) >100 mg/dL or were taking statins recruited for the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Exposures included race‐sex groups (white men [WM], black men [BM], white women [WW], black women [BW]) and factors that may influence healthcare utilization. Proportions and prevalence ratios were calculated for statin use and LDL‐C control. Statin use for WM, BM, WW, and BW was 66.0%, 57.8%, 55.0%, and 53.6%, respectively (P<0.001). After adjustment for healthcare utilization factors, statin use was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.96 [0.89‐1.03], 0.86 [0.80‐0.92], and 0.87 [0.81‐0.93], respectively, P<0.001). LDL‐C control among those taking statins for WM, BM, WW, and BW was 75.3%, 62.7%, 69.0%, and 56.0%, respectively (P<0.001). After adjustment, LDL‐C control was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.85 [0.79‐0.93], 0.89 [0.82‐0.96], and 0.73 [0.67‐0.80], respectively, P<0.001). Conclusions Race‐sex disparities in statin use and LDL‐C control were only partly explained by factors influencing health services utilization. Healthcare provider awareness of these disparities may help to close the observed race‐sex gaps in statin use and LDL‐C control among people with diabetes mellitus.
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Affiliation(s)
- Christopher M Gamboa
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, AL.,Weill Cornell Medical College, Weill Cornell Medicine, New York, NY
| | - Lisandro D Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Todd M Brown
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, AL
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
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24
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Howard G, Moy CS, Howard VJ, McClure LA, Kleindorfer DO, Kissela BM, Judd SE, Unverzagt FW, Soliman EZ, Safford MM, Cushman M, Flaherty ML, Wadley VG. Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality? Stroke 2016; 47:1893-8. [PMID: 27256672 PMCID: PMC4927373 DOI: 10.1161/strokeaha.115.012631] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. METHODS We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. RESULTS The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. CONCLUSIONS These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.
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Affiliation(s)
- George Howard
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
| | - Claudia S Moy
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Virginia J Howard
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Leslie A McClure
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Dawn O Kleindorfer
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Brett M Kissela
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Suzanne E Judd
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Fredrick W Unverzagt
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Elsayed Z Soliman
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Monika M Safford
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Mary Cushman
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Matthew L Flaherty
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
| | - Virginia G Wadley
- From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.)
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Guo S, Hu Y, Ding Y, Liu J, Zhang M, Ma R, Guo H, Wang K, He J, Yan Y, Rui D, Sun F, Mu L, Niu Q, Zhang J, Li S. Association between Eight Functional Polymorphisms and Haplotypes in the Cholesterol Ester Transfer Protein (CETP) Gene and Dyslipidemia in National Minority Adults in the Far West Region of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15979-92. [PMID: 26694435 PMCID: PMC4690972 DOI: 10.3390/ijerph121215036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/03/2015] [Accepted: 12/10/2015] [Indexed: 01/03/2023]
Abstract
We have investigated the relationship between the polymorphisms and haplotypes in the CETP gene, and dyslipidemia among the Xinjiang Kazak and Uyghur populations in China. A total of 712 patients with dyslipidemia and 764 control subjects of CETP gene polymorphism at rs12149545, rs3764261, rs1800775, rs711752, rs708272, rs289714, rs5882, and rs1801706 loci were studied by the Snapshot method, linkage disequilibrium analysis and haplotype construction. The results are as follows: (1) the minor allele of eight loci of frequencies in the two groups were different from other results of similar studies in other countries; (2) In the linear regression analysis, the HDL-C levels of rs708272 TT, rs1800775 AA, rs289714 CC and rs711752 AA genotypes were significantly higher than those of other genotypes, however, the rs3764261 GG and rs12149545 GG genotypes were significantly lower than those of other genotypes in the two ethnic groups. The HDL-C levels of the rs12149545 GG genotype were lower than those of other genotypes; (3) in the control group, the rs708272 CT genotype of TG levels were lower than in the CC genotype, the T genotype of LDL-C levels were lower than in the CC genotype, and the HDL-C levels were higher than in the CT genotype; the rs1800775 AC genotype of TG levels were higher than in the AA genotype, the rs711752 AG genotype of TG levels were lower than in the GG genotype, the AA genotype LDL-C levels were lower than in the GG genotype, and the HDL-C levels were higher than in the AG genotype; the rs1800775 AC genotype of TG levels were higher than in the AA genotype. In the dyslipidemia group, the rs708272 TT genotype of TC and LDL-C levels were higher than in the CT genotype and the rs3764261 TT genotype of TC levels were higher than in the GG genotype. The rs711752 AA genotype of TC and LDL-C levels were higher than in the AG genotype, and the rs12149545 AA genotype of TC and LDL-C levels were higher than in the GG genotype; (4) perfect Linkage Disequilibrium was observed for two sets of two SNPs: rs3764261 and rs12149545; rs711752 and rs708272. (5) Using SHEsis software analysis, the five A/T/A/A/T/C/A/G, A/T/A/A/T/T/G/A, G/G/A/G/C/C/G/G, G/G/C/G/C/C/A/G and G/G/C/G/C/T/G/G haplotypes were between dyslipidemia group and control group statistically significantly different (p < 0.05 in each case). The polymorphism of CETP genes rs708272, rs3764261, rs1800775, rs711752, rs12149545 was closely related to the dyslipidemia in the Xinjiang Uyghur and Kazakh ethnic groups; and the rs708272 T, rs3764261 T, rs711752 A, and rs12149545 A alleles could reduce risk of dyslipidemia in the Uyghur and Kazakh populations, however, the rs1800775 C allele showed risk factors.
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Affiliation(s)
- Shuxia Guo
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Yunhua Hu
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Yusong Ding
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Jiaming Liu
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Mei Zhang
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Rulin Ma
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Heng Guo
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Kui Wang
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Jia He
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Yizhong Yan
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Dongsheng Rui
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Feng Sun
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Lati Mu
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Qiang Niu
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Jingyu Zhang
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
| | - Shugang Li
- Department of Public Health and Key Laboratory of Xinjiang Endemic and Ethnic Diseases of the Ministry of Education, Shihezi University School of Medicine, Shihezi 832002, China.
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Safford MM, Gamboa CM, Durant RW, Brown TM, Glasser SP, Shikany JM, Zweifler RM, Howard G, Muntner P. Race-sex differences in the management of hyperlipidemia: the REasons for Geographic and Racial Differences in Stroke study. Am J Prev Med 2015; 48:520-7. [PMID: 25891050 PMCID: PMC4422177 DOI: 10.1016/j.amepre.2014.10.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lipid management is less aggressive in blacks than whites and women than men. PURPOSE To examine whether differences in lipid management for race-sex groups compared to white men are due to factors influencing health services utilization or physician prescribing patterns. METHODS Because coronary heart disease (CHD) risk influences physician prescribing, Adult Treatment Panel III CHD risk categories were constructed using baseline data from REasons for Geographic And Racial Differences in Stroke study participants (recruited 2003-2007). Prevalence, awareness, treatment, and control of hyperlipidemia were examined for race-sex groups across CHD risk categories. Multivariable models conducted in 2013 estimated prevalence ratios adjusted for predisposing, enabling, and need factors influencing health services utilization. RESULTS The analytic sample included 7,809 WM; 7,712 white women; 4,096 black men; and 6,594 black women. Except in the lowest risk group, black men were less aware of hyperlipidemia than others. A higher percentage of white men in the highest risk group was treated (83.2%) and controlled (72.8%) than others (treatment, 68.6%-72.1%; control, 52.2%-65.5%), with black women treated and controlled the least. These differences remained significant after adjustment for predisposing, enabling, and need factors. Stratified analyses demonstrated that treatment and control were lower for other race-sex groups relative to white men only in the highest risk category. CONCLUSIONS Hyperlipidemia was more aggressively treated and controlled among white men compared with white women, black men, and especially black women among those at highest risk for CHD. These differences were not attributable to factors influencing health services utilization.
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Affiliation(s)
- Monika M Safford
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
| | | | - Raegan W Durant
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Todd M Brown
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen P Glasser
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Shikany
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard M Zweifler
- Sentara Healthcare & Department of Neurology, Eastern Virginia Medical School, Norfolk, Virginia
| | - George Howard
- Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul Muntner
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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Bhatt H, Safford M, Stephen G. Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Curr Hypertens Rep 2015; 17:541. [PMID: 25794955 PMCID: PMC4443695 DOI: 10.1007/s11906-015-0541-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Monika Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Glasser Stephen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
- 1717 11th Avenue South, MT 634, Birmingham, AL 35205, USA
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28
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Brinjikji W, El-Sayed AM, Kallmes DF, Lanzino G, Cloft HJ. Racial and insurance based disparities in the treatment of carotid artery stenosis: a study of the Nationwide Inpatient Sample. J Neurointerv Surg 2014; 7:695-702. [DOI: 10.1136/neurintsurg-2014-011294] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/26/2014] [Indexed: 11/04/2022]
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Mallow JA, Theeke LA, Barnes ER, Whetsel T, Mallow BK. Using mHealth Tools to Improve Rural Diabetes Care Guided by the Chronic Care Model. ONLINE JOURNAL OF RURAL NURSING AND HEALTH CARE 2014; 14:43-65. [PMID: 26029005 DOI: 10.14574/ojrnhc.v14i1.276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Used as an integrated tool, mHealth may improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural, underserved populations. Our objective in this paper is to present an integrated review of the impact of mHealth interventions for community dwelling individuals with type two diabetes. MATERIALS AND METHODS A literature search was performed using keywords in PubMed to identify research studies which mHealth technology was used as the intervention. RESULTS AND DISCUSSION Interventions using mHealth have been found to improve outcomes, be cost effective, and culturally relevant. mHealth technology that has been used to improve outcomes include: seeking out health information via the web, access to appointment scheduling and medication refills, secure messaging, computerized interventions to manage a chronic condition, use of a personal health record, use of remote monitoring devices, and seeking support from others with similar health concerns through social networks. CONCLUSION Using the validated Chronic Care Model to translate what is known about mHealth technology to clinical practice has the potential to improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural underserved populations. While these approaches were effective in improving some outcomes, they have not resulted in the establishment of the necessary electronic infrastructure for a sustainable mobile healthcare delivery model.
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Shi L, Hu J, Zhu K, Fu Y, Xia R, Hu X. Changes of prevalence of dyslipidemia among adults: a cross-sectional study with a 2-year follow-up in urban southeast China. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.13.82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kimball MM, Neal D, Waters MF, Hoh BL. Race and Income Disparity in Ischemic Stroke Care: Nationwide Inpatient Sample Database, 2002 to 2008. J Stroke Cerebrovasc Dis 2014; 23:17-24. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/07/2012] [Accepted: 06/04/2012] [Indexed: 11/29/2022] Open
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Raji MA, Lowery M, Lin YL, Kuo YF, Baillargeon J, Goodwin JS. National utilization patterns of warfarin use in older patients with atrial fibrillation: a population-based study of Medicare Part D beneficiaries. Ann Pharmacother 2013; 47:35-42. [PMID: 23324508 DOI: 10.1345/aph.1r515] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ(2) was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS(2) score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05-1.16), having a PCP (OR 1.23; 95% CI 1.17-1.29), and CHADS(2) score of 2 or greater (OR 1.09; 95% CI 1.01-1.17) were associated with increased odds of warfarin use. CONCLUSIONS Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use.
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Affiliation(s)
- Mukaila A Raji
- Division of Geriatrics; Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch (UTMB), Galveston, TX, USA.
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