Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As high‐sensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan‐do‐check‐adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular‐related health disparities, and ultimately improve and save lives.

Regional variations in spermine levels in the developing rat brain following exposure to lead

Polyamines are ubiquitous compounds involved in growth and differentiation, and omithine decarboxylase (ODC), is their rate-limiting enzyme. In an effort to examine whether changes in ODC enzyme activity are reflected in alterations in the availability of polyamines, levels of the more stable end-product spermine, were examined following exposure to lead (Pb). Rats were lactationally exposed to 0.2% Pb-acetate from birth to weaning. At postnatal days 3, 5, 10, 15, and 20, pups were sacrificed, and spermine was extracted from their brain tissue and the extracts were analyzed by high-performance liquid chromatography coupled with a fluorescence detector. Basal spermine levels in the cerebellum were found to be higher than those in the neocortex, and exhibited a characteristic developmental profile. In Pb-exposed animals, spermine levels were attenuated in both brain regions, however, there was a rebound in cerebellar levels during the third week after birth. While basal spermine levels are in concert with reported patterns of ODC activity, they depart from each other following a toxic challenge to the cerebellum. This study suggest that developmental polyamine levels are not necessarily a direct translation of ODC activity and that modulations in their biosynthesis depend on regional stages of growth.