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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Garg M, Creechan P, Sadeghpour A, Abramov D, Dani SS, Ganatra S, Al-Kindi SG, Michos ED, Misra A, Deswal A, Palaskas NL, Virani SS, Nambi V, Minhas AMK. Trends of Cardiovascular Disease-Related Mortality in Breast Cancer in the United States From 1999 to 2019. Am J Cardiol 2024:S0002-9149(24)00276-5. [PMID: 38643926 DOI: 10.1016/j.amjcard.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Affiliation(s)
| | | | - Anita Sadeghpour
- MedStar Health Research Institute, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Sarju Ganatra
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Sadeer G Al-Kindi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicolas L Palaskas
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Vijay Nambi
- Department of Medicine; Section of Cardiology, and
| | - Abdul Mannan Khan Minhas
- Department of Medicine; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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Kotta PA, Nambi V, Misra A, Afshar H, Chelu MG, Nasir K, Abramov D, Khan Minhas AM. Association between neighborhood household income and inpatient atrial fibrillation outcomes. Heart Rhythm 2024:S1547-5271(24)00203-0. [PMID: 38382688 DOI: 10.1016/j.hrthm.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The impact of socioeconomic status on the clinical outcomes of patients admitted to the hospital for atrial fibrillation (AF) is not well described. OBJECTIVE The purpose of this study was to determine the association between median neighborhood household income (mNHI) and clinical outcomes among patients admitted to the hospital for AF. METHODS We retrospectively analyzed primary AF hospitalizations from the United States National Inpatient Sample between 2016 and 2020. The analyzed sample was divided into quartiles based on the mNHI in the zip code of the patient's residence. The lowest quartile was used as the reference category. Study outcomes included inpatient procedure utilization (ablation, cardioversion, percutaneous left atrial appendage closure), length of stay, cost, mortality, and disposition. Weighted multivariable logistic and linear regression, adjusting for multiple patient and hospital-level characteristics, was performed. RESULTS Patients in the highest mNHI quartile had lower comorbidity burden, lower in-hospital mortality (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.7-0.87; P <.001), lower discharges to care facility (OR 0.86; 95% CI 0.83-0.9; P <.001), shorter length of stay (adjusted mean difference -0.26; 95% CI -0.30 to -0.22; P <.001), higher procedure utilization, and higher health care costs ($12,124 vs $10,018) compared to the lowest mNHI quartile patients. CONCLUSION We identified significantly higher in-hospital mortality and lower procedural/resource utilization in patients living in lower-income neighborhoods compared to higher-income neighborhoods. Further research is needed to better understand the drivers of these disparities and the strategies to improve health care disparities between socioeconomic groups.
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Affiliation(s)
- Prasanti A Kotta
- Baylor College of Medicine, Department of Internal Medicine, Houston, Texas.
| | - Vijay Nambi
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Arunima Misra
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Hamid Afshar
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Section of Cardiology, Houston, Texas
| | - Mihail G Chelu
- Baylor College of Medicine, Department of Internal Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Section of Cardiology, Houston, Texas
| | - Dmitry Abramov
- Loma Linda, University Health, Department of Cardiology, Loma Linda, California
| | - Abdul Mannan Khan Minhas
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Minhas AMK, Talha KM, Abramov D, Johnson HM, Antoine S, Rodriguez F, Fudim M, Michos ED, Misra A, Abushamat L, Nambi V, Fonarow GC, Ballantyne CM, Virani SS. Racial and ethnic disparities in cardiovascular disease - analysis across major US national databases. J Natl Med Assoc 2024:S0027-9684(24)00022-1. [PMID: 38342731 DOI: 10.1016/j.jnma.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND There are several studies that have analyzed disparities in cardiovascular disease (CVD) health using a variety of different administrative databases; however, a unified analysis of major databases does not exist. In this analysis of multiple publicly available datasets, we sought to examine racial and ethnic disparities in different aspects of CVD, CVD-related risk factors, CVD-related morbidity and mortality, and CVD trainee representation in the US. METHODS We used National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, National Inpatient Sample, Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research, United Network for Organ Sharing, and American Commission for Graduate Medical Education data to evaluate CVD-related disparities among Non-Hispanic (NH) White, NH Black and Hispanic populations. RESULTS The prevalence of most CVDs and associated risk factors was higher in NH Black adults compared to NH White adults, except for dyslipidemia and ischemic heart disease (IHD). Statins were underutilized in IHD in NH Black and Hispanic patients. Hospitalizations for HF and stroke were higher among Black patients compared to White patients. All-cause, CVD, heart failure, acute myocardial infarction, IHD, diabetes mellitus, hypertension and cerebrovascular disease related mortality was highest in NH Black or African American individuals. The number of NH Black and Hispanic trainees in adult general CVD fellowship programs was disproportionately lower than NH White trainees. CONCLUSION Racial disparities are pervasive across the spectrum of CVDs with NH Black adults at a significant disadvantage compared to NH White adults for most CVDs.
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Affiliation(s)
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Heather M Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Baptist Health South Florida, Boca Raton, FL, USA
| | - Steve Antoine
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fatima Rodriguez
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Stanford, CA, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Layla Abushamat
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Vijay Nambi
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles CA, USA
| | - Christie M Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Aga Khan University, Karachi, Pakistan
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Minhas AMK, Cullen MW, Mamas MA, Fudim M, Virani SS, Khan SS, Misra A, Ballantyne CM, Nambi V, Abramov D. Association Between Cardiologist Density and Mortality in Urban and Rural Counties in the United States. Am J Cardiol 2024; 210:279-282. [PMID: 37844717 DOI: 10.1016/j.amjcard.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Abdul Mannan Khan Minhas
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, Texas
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California.
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Minhas AMK, Parwani P, Fudim M, Virani SS, Khan SS, Cullen MW, Misra A, Ballantyne C, Nambi V, Abramov D. County-Level Cardiologist Density and Mortality in the United States. J Am Heart Assoc 2023; 12:e031686. [PMID: 38014694 PMCID: PMC10727342 DOI: 10.1161/jaha.123.031686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
| | - Purvi Parwani
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
| | - Marat Fudim
- Department of MedicineDuke University Medical CenterDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Salim S. Virani
- Aga Khan UniversityKarachiPakistan
- Baylor College of Medicine and Texas Heart InstituteHoustonTX
| | - Sadiya S. Khan
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Arunima Misra
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Christie Ballantyne
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Vijay Nambi
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
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Harrison D, Misra A, Pahwa A, Muradali K, Sherman S. Things We Do for No Reason™: Routinely obtaining repeat transthoracic echocardiography for acute decompensation of known chronic heart failure. J Hosp Med 2023; 18:934-937. [PMID: 36739110 DOI: 10.1002/jhm.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/19/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2023]
Affiliation(s)
- Darren Harrison
- Section of Cardiology, Department of Medicine, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amit Pahwa
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Komal Muradali
- Department of Medicine, Division of Hospital Medicine, University of Texas Southwestern, Houston, Texas, USA
| | - Stephanie Sherman
- Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Krittanawong C, Rodriguez M, Lui M, Misra A, Tang WHW, Bozkurt B, Yancy CW. Misconceptions and Facts about Heart Failure with Reduced Ejection Fraction. Am J Med 2023; 136:422-431. [PMID: 36740210 DOI: 10.1016/j.amjmed.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Heart failure with reduced ejection fraction is a significant driver of morbidity and mortality. There are common misconceptions regarding the disease processes underlying heart failure and best practices for therapy. The terms heart failure with reduced ejection fraction and left ventricular systolic dysfunction are not interchangeable terms. Key therapies for heart failure with reduced ejection fraction target the underlying disease processes, not the left ventricular ejection fraction alone. The absence of congestion does not rule out heart failure. Patients with cardiac amyloidosis can also present with heart failure with reduced ejection fraction. A rise in serum creatinine in acute heart failure exacerbation is not associated with tubular injury. Guideline directed medical therapy should be continued during acute exacerbations of heart failure with reduced ejection fraction and should be started in the same hospitalization in new diagnoses. Marginal blood pressure is not a relative contraindication to optimal guideline directed medical therapy. Guideline directed medical therapy should be continued even if ejection fraction improves. There are other therapies that provide significant benefit besides the four key medications in guideline directed medical therapy.
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Affiliation(s)
| | - Mario Rodriguez
- John T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine, Mo
| | - Matthew Lui
- John T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine, Mo
| | - Arunima Misra
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - Biykem Bozkurt
- Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, DeBakey VA Medical Center, Houston, Texas
| | - Clyde W Yancy
- Chief, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Ill
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Sureka S, Misra A, Raj H, Singh U. Evaluation of different pneumoperitoneal pressures with respect to technical feasibility and physiological parameters in laparoscopic renal surgery: A prospective and randomized study to determine the safe pressure. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Henneberg J, Grohmann-Izay B, Huang C, Schulze C, Llinas N, Giorgi D, Misra A, Pominchuk D, Prokhorof A, Rapoport B, Semiglazov V, Tseng L, Yanez Ruiz E, Loibl S. A Phase III, Randomized, Multicenter, Double-blind Study to Compare Efficacy and Safety of EG12014 (EirGenix Trastuzumab) with Herceptin® as Neoadjuvant Treatment in Combination with Anthracycline/Paclitaxel-based Systemic Therapy in Patients with HER2-positive Early Breast Cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, Shah ZI, Shenoy C, Spinler SA, Vallurupalli S, Lip GYH. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e205-e223. [PMID: 36106537 DOI: 10.1161/cir.0000000000001092] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.
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Pasqualin G, Misra A, Gauvreau K, Desai AS, Prakash A, Sanders S, Givertz MM, Valente AM. Ventricular-arterial coupling predicts outcomes in adults with a systemic right ventricle. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with a systemic right ventricle (SRV) and biventricular circulation experience high incidence of cardiovascular morbidities and decreased survival [1]. Non-invasive measures of subclinical ventricular dysfunction are needed to appropriately identify patients at increased risk for adverse outcomes. Ventricular-arterial coupling (VAC), the ratio between the effective arterial elastance (Ea) and ventricular end-systolic elastance (Ees), may predict clinical outcomes in patients with SRV [2].
Objectives
To assess VAC in adults with SRV and evaluate its correlation with clinical outcomes.
Methods
Consecutive cardiovascular magnetic resonance (CMR) examinations of adults with D-loop transposition of great arteries (TGA) after atrial switch operation and L-loop TGA performed at Boston Children's Hospital between 2005 and 2019 were analyzed. VAC was calculated as Ea/Ees (Ea = mean arterial blood pressure (MBP)/ventricular stroke volume; Ees = MBP/end-systolic volume). Global myocardial strain was measured by feature tracking analysis on cine steady-state free precession sequences. Cox proportional hazards regression analysis was performed to assess the association of SRV functional parameters with clinical outcomes. The analysis was adjusted for age, sex, and body mass index. The primary outcome was defined as a composite of death, cardiovascular arrest, hospitalizations for heart failure (HF); the secondary outcome as atrial arrhythmias; the tertiary outcome included other causes of cardiovascular hospitalizations (percutaneous or surgical interventions, device implantation, other cardiovascular disease). Cumulative incidence of the study outcomes was estimated using Kaplan-Meier method.
Results
One hundred sixty-seven adults (mean age 32±10 years, 59% men) with SRV were analyzed. Patients with HF (n=48, 29%) had higher VAC values as compared to those without HF (1.4±0.8 vs. 1.1±0.5, p=0.01). Over a mean follow-up of 6.5±4.2 years, 15 over 139 patients (11%) experienced the primary outcome with an incidence rate of 1.7 per 100 patient-years (95% confidence interval (CI), 1.04–2.85). Higher VAC values were significantly associated with an increased risk of the primary outcome (p for trend = 0.01, Figure 1). VAC was the only functional parameter associated with the primary outcome (hazard ratio (HR) 1.99, 95% CI: 1.06–3.73, p=0.031), secondary outcome (HR 2.33, 95% CI: 1.12–4.82, p=0.023) and tertiary outcome (HR 1.63, 95% CI: 1.09–2.44, p=0.018) in the adjusted analysis (Table 1). Ejection fraction (EF) was not associated with the study outcomes in the adjusted analysis (p>0.05, Table 1) whereas global circumferential and radial strain showed an association limited to the tertiary endpoint (p=0.004, Table 1).
Conclusions
CMR-derived VAC is associated with adverse outcomes in SRV patients and may improve risk stratification of this unique population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pasqualin
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A Misra
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - K Gauvreau
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A S Desai
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A Prakash
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - S Sanders
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - M M Givertz
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A M Valente
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
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Bozkurt B, Nair AP, Misra A, Scott CZ, Mahar JH, Fedson S. Neprilysin Inhibitors in Heart Failure: The Science, Mechanism of Action, Clinical Studies, and Unanswered Questions. JACC Basic Transl Sci 2022; 8:88-105. [PMID: 36777165 PMCID: PMC9911324 DOI: 10.1016/j.jacbts.2022.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
This article provides a contemporary review and a new perspective on the role of neprilysin inhibition in heart failure (HF) in the context of recent clinical trials and addresses potential mechanisms and unanswered questions in certain HF patient populations. Neprilysin is an endopeptidase that cleaves a variety of peptides such as natriuretic peptides, bradykinin, adrenomedullin, substance P, angiotensin I and II, and endothelin. It has a broad role in cardiovascular, renal, pulmonary, gastrointestinal, endocrine, and neurologic functions. The combined angiotensin receptor and neprilysin inhibitor (ARNi) has been developed with an intent to increase vasodilatory natriuretic peptides and prevent counterregulatory activation of the angiotensin system. ARNi therapy is very effective in reducing the risks of death and hospitalization for HF in patients with HF and New York Heart Association functional class II to III symptoms, but studies failed to show any benefits with ARNi when compared with angiotensin-converting enzyme inhibitors or angiotensin receptor blocker in patients with advanced HF with reduced ejection fraction or in patients following myocardial infarction with left ventricular dysfunction but without HF. These raise the questions about whether the enzymatic breakdown of natriuretic peptides may not be a very effective solution in advanced HF patients when there is downstream blunting of the response to natriuretic peptides or among post-myocardial infarction patients in the absence of HF when there may not be a need for increased natriuretic peptide availability. Furthermore, there is a need for additional studies to determine the long-term effects of ARNi on albuminuria, obesity, glycemic control and lipid profile, blood pressure, and cognitive function in patients with HF.
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Key Words
- ACE, angiotensin-converting enzyme
- ANP, atrial natriuretic peptide
- ARB, angiotensin receptor blocker
- ARN, angiotensin receptor–neprilysin
- ARNi
- Aβ, amyloid beta
- BNP, brain natriuretic peptide
- BP, blood pressure
- CSF, cerebrospinal fluid
- EF, ejection fraction
- FDA, U.S. Food and Drug Administration
- GFR, glomerular filtration rate
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- NEP inhibitor
- NT-proBNP, N-terminal pro–brain natriuretic peptide
- NYHA, New York Heart Association
- PDE, phosphodiesterase
- RAAS, renin-angiotensin-aldosterone system
- UACR, urinary albumin/creatine ratio
- angiotensin receptor–neprilysin inhibitor
- cGMP, cyclic guanosine monophosphate
- eGFR, estimated glomerular filtration rate
- heart failure
- neprilysin
- neprilysin inhibitor
- sacubitril
- sacubitril/valsartan
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Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, DeBakey Veterans Affairs Medical Center, Houston Texas, USA
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston Texas, USA
- Address for correspondence: Dr Biykem Bozkurt, MEDVAMC, 2002 Holcombe Boulevard, Houston, Texas, 77030, USA.
| | - Ajith P. Nair
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Arunima Misra
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston Texas, USA
| | - Claire Z. Scott
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jamal H. Mahar
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Savitri Fedson
- Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston Texas, USA
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15
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Jain V, Al Rifai M, Khan SU, Kalra A, Rodriguez F, Samad Z, Pokharel Y, Misra A, Sperling LS, Rana JS, Ullah W, Medhekar A, Virani SS. Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study. J Am Heart Assoc 2022; 11:e024414. [PMID: 35904206 PMCID: PMC9375494 DOI: 10.1161/jaha.121.024414] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self‐reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD). Methods and Results We performed a retrospective cohort analysis of adults (≥18 years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self‐reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first—participant lives in the least vulnerable group of states, 0–0.32; to third—participant lives in the most vulnerable group of states, 0.54–1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1 745 999 participants ≥18 years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11–1.17]), diabetes (OR, 1.12 [95% CI, 1.09–1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06–1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12–1.23]), smoking (OR, 1.05 [95% CI, 1.03–1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12–1.19]), compared with those living in the first tertile of SVI. Conclusions SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular‐related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.
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Affiliation(s)
- Vardhmaan Jain
- Department of Internal Medicine Cleveland Clinic Foundation Cleveland OH
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center Indiana University School of Medicine Indianapolis IN
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Zainab Samad
- Department of Cardiovascular Medicine Aga Khan University Karachi Pakistan
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Medicine Wake Forest Baptist Health Winston-Salem NC
| | - Arunima Misra
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Laurence S Sperling
- Division of Cardiovascular Medicine Emory University School of Medicine Atlanta GA
| | - Jamal S Rana
- Division of Cardiovascular Medicine Kaiser Permanente Oakland Medical Center Oakland CA
| | - Waqas Ullah
- Division of Cardiovascular Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Ankit Medhekar
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX.,Section of Health Services Research, Department of Medicine Baylor College of Medicine Houston TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center Houston TX
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16
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Al Rifai M, Newby LK, Nair AP, Misra A, Rogers JG, Fedson S, Virani SS. SGLT-2 Inhibitors for Patients with Heart Failure: What Have We Learned Recently? Curr Atheroscler Rep 2022; 24:627-634. [PMID: 35653033 DOI: 10.1007/s11883-022-01038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss the mechanisms of action of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and the purported protective effects for mitigating heart failure (HF)-related outcomes. RECENT FINDINGS Major randomized clinical trials have demonstrated the cardiovascular safety and efficacy of SGLT-2i among patients without known HF and those with established HF with reduced ejection fraction or preserved ejection fraction (HFrEF and HFpEF respectively). Recent HF guidelines have incorporated SGLT-2i in HF treatment algorithms. SGLT-2i have emerged as a novel treatment for both prevention of HF and reduction of cardiovascular morbidity and mortality among patients with existing HFrEF or HFpEF.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - L Kristin Newby
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Raleigh, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Raleigh, NC, USA
| | - Ajith P Nair
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Joseph G Rogers
- Division of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Savitri Fedson
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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17
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Kianoush S, Al-Rifai M, Kalra A, Bk A, Mehta A, Sadaf MI, Misra A, Khalid U, Lavie CJ, Kayani WT, Virani SS. Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study. Curr Probl Cardiol 2022:101241. [PMID: 35513186 DOI: 10.1016/j.cpcardiol.2022.101241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al-Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Anupama Bk
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Murrium I Sadaf
- Division of Cardiology, University of Arkansas Medical Center, Little Rock, AR
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Umair Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Waleed T Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX.
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18
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Abstract
Heart failure (HF) is a major health problem worldwide. The development of effective drug and/or device therapy is crucial to mitigate the significant morbidity, mortality and healthcare costs associated with HF. The choice of endpoint in clinical trials has important practical and clinical implications. Outcomes of interest including mortality and HF hospitalisations provide robust evidence for regulatory approval granted there is sufficiency of safety data. At the same time, it is important to recognise that HF patients experience significant impairments in functional capacity and quality of life, underscoring the need to incorporate parameters of symptoms and patient-reported outcomes in clinical trials. In this review, the authors summarise the evolution and definition of cardiovascular endpoints used in clinical trials, discuss approaches to study design to allow the incorporation of mortality, morbidity and functional endpoints and, finally, examine the current challenges and suggest steps for the development of cardiovascular endpoints that are effective, meaningful and meet the needs of all relevant stakeholders, including patients, physicians regulators and sponsors.
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Affiliation(s)
- Aliza Hussain
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US
| | - Arunima Misra
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, US
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19
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Kherallah RY, Al Rifai M, Liu J, Kianoush S, Misra A, Virani SS. Mental Health and Access to Medical Care in Patients with Chronic Cardiovascular Conditions: An Analysis of the Behavior Risk Factor Surveillance System. Kans J Med 2022; 15:17-21. [PMID: 35106118 PMCID: PMC8765506 DOI: 10.17161/kjm.vol15.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Poor mental health is associated with worse outcomes for chronic diseases. It is unclear whether mental illness predisposes to difficulties with healthcare access. Methods Using a combined dataset of the 2016–2019 Behavioral Risk Factor Surveillance System, this study focused on individuals who reported a chronic cardiovascular condition. Weighted multivariable logistic regression analyses were used to explore the association between domains of mental health and measures of healthcare access including delaying medical care, more than one year since last routine checkup, lack of a primary care physician, and cost-related medication nonadherence. Results Among 1,747,397 participants, 27% had a chronic cardiovascular condition, 12% had clinical depression, and 12% had poor mental health. Those with poor mental health (OR 3.20 [3.08 – 3.33]) and clinical depression (OR 2.43 [2.35 – 2.52]) were more likely to report delays in medical care. Those with greater stress frequency (OR 8.47 [6.84 – 10.49] stressed all of the time), lower levels of emotional support received (OR 3.07 [2.21 – 4.26] rarely get needed emotional support), and greater life dissatisfaction (6.66 [4.14 – 10.70] very dissatisfied) reported greater delays in medical care. Conclusions Individuals with poor mental health have greater difficulty accessing medical care independent of socioeconomic variables.
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Affiliation(s)
| | - Mahmoud Al Rifai
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Jing Liu
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Sina Kianoush
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Baylor College of Medicine, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
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20
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Shaw S, Patra A, Misra A, Nayak MK, Chamkha AJ. A Numerical Approach to the Modeling of Thomson and Troian Slip on Nonlinear Radiative Microrotation of Casson Carreau Nanomaterials in Magnetohydrodynamics. j nanofluids 2021. [DOI: 10.1166/jon.2021.1790] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The goal of the current work is to explore the influence of Thompson and Troian slip on the hydromagnetic microrotations of Carreau nanomaterials over a linearly stretched surface subject to NLTR, viscous dissipation, Newtonian heating, homogenous and heterogeneous reactions. Effect
of non linear slip (Thompson and Troian slip) on non Newtonian nanofluid (Carreau nanofluid) subject to microrotation is the novelty of the investigation. Shooting technique is the instrumental to get appropriate numerical solution. The significant outcomes of the current study are that Casson
parameter and Weissenberg number exhibit opposite results for velocity and heat transfer rate due to flow of micropolar Carreau nanofluid. Further, more and more Thompson and Troian slip yields diminution of flow velocity as well as microrotations. Amplifying Casson parameter intensifies the
HTR from the stretched surface.
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Affiliation(s)
- S. Shaw
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana
| | - A. Patra
- Department of Mathematics, Govt. Autonomous College, Rourkela, Odisha 769004, India
| | - A. Misra
- Department of Mathematics, Centurion University of Technology and Management, Paralakhemundi, Gajapati 761211, Odisha, India
| | - M. K. Nayak
- Department of Mechanical Engineering, FET, ITER, Siksha ‘O’ Anusandhan University, Bhubaneswar 751030, India
| | - Ali J. Chamkha
- Faculty of Engineering, Kuwait College of Science and Technology, Doha District, 35004, Kuwait
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21
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Kurup R, Misra A, Patel S. Colchicine suppresses atherosclerotic plaque development and modulates atherogenic vascular smooth muscle cell and monocyte behaviour. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Nolan MS, Aguilar D, Misra A, Gunter SM, Erickson T, Gorchakov R, Rivera H, Montgomery SP, Murray KO. Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA. Emerg Infect Dis 2021; 27:1958-1960. [PMID: 34152952 PMCID: PMC8237890 DOI: 10.3201/eid2707.203244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate possible cardiac manifestations of Chagas disease, we tested 97 Latinx patients with nonischemic cardiomyopathy in Houston, Texas, USA, for Trypanosoma cruzi infection. We noted a high prevalence of underdiagnosed infection and discrepant results in clinical diagnostic assays. Latinx cardiac patients in the United States would benefit from laboratory screening for T. cruzi infection.
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23
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Lee MT, Mahtta D, Ramsey DJ, Liu J, Misra A, Nasir K, Samad Z, Itchhaporia D, Khan SU, Schofield RS, Ballantyne CM, Petersen LA, Virani SS. Sex-Related Disparities in Cardiovascular Health Care Among Patients With Premature Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2021; 6:782-790. [PMID: 33881448 DOI: 10.1001/jamacardio.2021.0683] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance There is a paucity of data regarding secondary prevention care disparities in women with premature and extremely premature atherosclerotic cardiovascular disease (ASCVD), defined as an ASCVD event at 55 years or younger and 40 years or younger, respectively. Objective To evaluate sex-based differences in antiplatelet agents, any statin, high-intensity statin (HIS) therapy, and statin adherence in patients with premature and extremely premature ASCVD. Design, Setting, and Participants This was a cross-sectional, multicenter, nationwide VA health care system-based study with patients enrolled in the Veterans With Premature Atherosclerosis (VITAL) registry. The study assessed patients who had at least 1 primary care visit in the Veterans Affairs (VA) health care system from October 1, 2014, to September 30, 2015. Participants included 147 600 veteran patients with premature ASCVD, encompassing ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Exposures Women vs men with premature and extremely premature ASCVD. Main Outcomes and Measures Antiplatelet use, any statin use, HIS use, and statin adherence (proportion of days covered [PDC] ≥0.8). Results We identified 10 413 women and 137 187 men with premature ASCVD (age ≤55 years) and 1340 women and 8145 men with extremely premature (age ≤40 years) ASCVD. Among patients with premature and extremely premature ASCVD, women represented 7.1% and 14.1% of those groups, respectively. When compared with men, women with premature ASCVD had a higher proportion of African American patients (36.1% vs 23.8%) and lower proportions of Asian patients (0.5% vs 0.7%) and White patients (56.1% vs. 68.1%). In the extremely premature ASCVD group, women had a comparatively higher proportion of African American patients (36.8% vs 23.2%) and lower proportion of White patients (55.0% vs 67.8%) and Asian patients (1.3% vs 1.5%) than men. Among patients with premature IHD, women received less antiplatelet (adjusted odds ratio [AOR], 0.47, 95% CI, 0.45-0.50), any statin (AOR, 0.62; 95% CI, 0.59-0.66), and HIS (AOR, 0.63; 95% CI, 0.59-0.66) therapy and were less statin adherent (mean [SD] PDC, 0.68 [0.34] vs 0.73 [0.31]; β coefficient: -0.02; 95% CI, -0.03 to -0.01) compared with men. Similarly, women with premature ICVD and premature PAD received comparatively less antiplatelet agents, any statin, and HIS. Among patients with extremely premature ASCVD, women also received less antiplatelet therapy (AOR, 0.61; 95% CI, 0.53-0.70), any statin therapy (AOR,0.51; 95% CI, 0.44-0.58), and HIS therapy (AOR, 0.45; 95% CI, 0.37-0.54) than men. There were no sex-associated differences in statin adherence among patients with premature ICVD, premature PAD, or extremely premature ASCVD. Conclusions and Relevance This cross-sectional study revealed that women veterans with premature ASCVD and extremely premature ASCVD receive less optimal secondary prevention cardiovascular care in comparison with men. Women with premature ASCVD, particularly those with IHD, were also less statin adherent. Multidisciplinary and patient-centered interventions are needed to improve these disparities in women.
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Affiliation(s)
- Michelle T Lee
- Health Policy, Quality and Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Dhruv Mahtta
- Health Policy, Quality and Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David J Ramsey
- Health Policy, Quality and Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas
| | - Jing Liu
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Khurram Nasir
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Zainab Samad
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Dipti Itchhaporia
- Department of Medicine, Cardiology Division, Hoag Memorial Hospital, University of California at Irvine
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown
| | - Richard S Schofield
- Division of Cardiovascular Medicine, University of Florida, Gainesville.,Department of Veterans Affairs Medical Center, Gainesville, Florida
| | - Christie M Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Laura A Petersen
- Health Policy, Quality and Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Salim S Virani
- Health Policy, Quality and Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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24
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Ali S, McClafferty A, Misra A. ST ELEVATION MYOCARDIAL INFARCTION FOLLOWING VAPING-ASSOCIATED PULMONARY INJURY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Nilavarasan T, Joshi GN, Misra A, Manisankar C, Verma SB. Topological modifications due to ramped vanes in a flare-induced shock–boundary layer interaction flowfield. J Vis (Tokyo) 2021. [DOI: 10.1007/s12650-020-00735-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Lyons TP, Gillard D, Molina-Sánchez A, Misra A, Withers F, Keatley PS, Kozikov A, Taniguchi T, Watanabe K, Novoselov KS, Fernández-Rossier J, Tartakovskii AI. Interplay between spin proximity effect and charge-dependent exciton dynamics in MoSe 2/CrBr 3 van der Waals heterostructures. Nat Commun 2020; 11:6021. [PMID: 33244001 PMCID: PMC7691354 DOI: 10.1038/s41467-020-19816-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
Semiconducting ferromagnet-nonmagnet interfaces in van der Waals heterostructures present a unique opportunity to investigate magnetic proximity interactions dependent upon a multitude of phenomena including valley and layer pseudospins, moiré periodicity, or exceptionally strong Coulomb binding. Here, we report a charge-state dependency of the magnetic proximity effects between MoSe2 and CrBr3 in photoluminescence, whereby the valley polarization of the MoSe2 trion state conforms closely to the local CrBr3 magnetization, while the neutral exciton state remains insensitive to the ferromagnet. We attribute this to spin-dependent interlayer charge transfer occurring on timescales between the exciton and trion radiative lifetimes. Going further, we uncover by both the magneto-optical Kerr effect and photoluminescence a domain-like spatial topography of contrasting valley polarization, which we infer to be labyrinthine or otherwise highly intricate, with features smaller than 400 nm corresponding to our optical resolution. Our findings offer a unique insight into the interplay between short-lived valley excitons and spin-dependent interlayer tunneling, while also highlighting MoSe2 as a promising candidate to optically interface with exotic spin textures in van der Waals structures.
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Affiliation(s)
- T P Lyons
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK.
| | - D Gillard
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK
| | - A Molina-Sánchez
- QuantaLab, International Iberian Nanotechnology Laboratory, Braga, 4715-330, Portugal
| | - A Misra
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
- Department of Physics, Indian Institute of Technology Madras (IIT Madras), Chennai, India
| | - F Withers
- Department of Physics and Astronomy, University of Exeter, Exeter, EX4 4QL, UK
| | - P S Keatley
- Department of Physics and Astronomy, University of Exeter, Exeter, EX4 4QL, UK
| | - A Kozikov
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - T Taniguchi
- National Institute for Materials Science, Tsukuba, Ibaraki, 305-0044, Japan
| | - K Watanabe
- National Institute for Materials Science, Tsukuba, Ibaraki, 305-0044, Japan
| | - K S Novoselov
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
- Centre for Advanced 2D Materials, National University of Singapore, Singapore, 117546, Singapore
- Chongqing 2D Materials Institute, Liangjiang New Area, Chongqing, 400714, China
| | - J Fernández-Rossier
- QuantaLab, International Iberian Nanotechnology Laboratory, Braga, 4715-330, Portugal
| | - A I Tartakovskii
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK.
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Chang A, Yang Y, Giorgberidze I, Afshar H, Schurmann P, Misra A. Remote Monitoring of Heart Failure Using A Device-Based Multisensor Algorithm. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caballero AE, Ceriello A, Misra A, Aschner P, McDonnell ME, Hassanein M, Ji L, Mbanya JC, Fonseca VA. COVID-19 in people living with diabetes: An international consensus. J Diabetes Complications 2020; 34:107671. [PMID: 32651031 PMCID: PMC7336933 DOI: 10.1016/j.jdiacomp.2020.107671] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.
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Affiliation(s)
- A E Caballero
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - A Misra
- Fortis-C-DOC Center of Excellence for Diabetes, Metabolic Disease and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation, New Dheli, India
| | - P Aschner
- San Ignacio University Hospital, Javeriana University School of Medicine, Bogota, Colombia
| | - M E McDonnell
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Hassanein
- Dubai Hospital, Endocrine Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - L Ji
- Peking University People's Hospital, Peking University, Beijing, China
| | - J C Mbanya
- Central Hospital, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - V A Fonseca
- Tulane University Medical Center, Tulane University Medical School, New Orleans, USA
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Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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30
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Tucker B, Vaidya K, Kurup R, Khandkar C, Pandzic E, Barraclough J, Misra A, Kavurma M, Martinez G, Rye K, Cochran B, Patel S. 461 Colchicine Inhibits Neutrophil Extracellular Trap Formation in Acute Coronary Syndrome Patients Post Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Misra A, Wiens D, Kassam H, Gill R, Borgia SM. A191 HCV SCREENING VIA RAPID POINT OF CARE TESTING IN PATIENTS ON OPIATE SUBSTITUTION THERAPY IN PEEL REGION, CANADA. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Misra
- McMaster University, Hamilton, ON, Canada
| | - D Wiens
- New Direction Addiction Clinic, Brampton, ON, Canada
| | - H Kassam
- Vector Health Clinics, Mississauga, ON, Canada
| | - R Gill
- Bloom Clinic, Bramalea Community Health Centre, Brampton, ON, Canada
| | - S M Borgia
- William Osler Health System, Brampton Civic Hospital, Brampton, ON, Canada
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33
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Khalaf S, Owen B, Misra A. THE DAY THE HEART WANDERED OFF. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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34
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Misra A, Soares MJ, Mohan V, Anoop S, Abhishek V, Vaidya R, Pradeepa R. Body fat, metabolic syndrome and hyperglycemia in South Asians. J Diabetes Complications 2018; 32:1068-1075. [PMID: 30115487 DOI: 10.1016/j.jdiacomp.2018.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.
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Affiliation(s)
- A Misra
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India.
| | - Mario J Soares
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Shajith Anoop
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India
| | - Vishnu Abhishek
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ruchi Vaidya
- Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajendra Pradeepa
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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35
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Misra A, Deswal A. NT-proBNP-guided and conventional therapies did not differ for readmission or mortality in acute decompensated HF. Ann Intern Med 2018; 169:JC21. [PMID: 30128511 DOI: 10.7326/acpjc-2018-169-4-021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Anita Deswal
- Baylor College of Medicine & VA Medical CenterHouston, Texas, USA
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36
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Pham D, Addison D, Kayani W, Misra A, Jneid H, Resar J, Lakkis N, Alam M. Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis. Emerg Med J 2018; 35:559-563. [PMID: 29921621 DOI: 10.1136/emermed-2017-207065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Beta blockers (β-blockers) remain a standard therapy in the early treatment of acute coronary syndromes. However, β-blocker therapy in patients with cocaine-associated chest pain (CACP) continues to be an area of debate due to the potential risk of unopposed α-adrenergic stimulation and coronary vasospasm. Therefore, we performed a systematic review and meta-analysis of available studies to compare outcomes of β-blocker versus no β-blocker use among patients with CACP. METHODS We searched the MEDLINE and EMBASE databases through September 2016 using the keywords 'beta blocker', 'cocaine' and commonly used β-blockers ('atenolol', 'bisoprolol', 'carvedilol', 'esmolol', 'metoprolol' and 'propranolol') to identify studies evaluating β-blocker use among patients with CACP. We specifically focused on studies comparing outcomes between β-blocker versus no β-blocker usage in patients with CACP. Studies without a comparison between β-blocker and no β-blocker use were excluded. Outcomes of interest included non-fatal myocardial infarction (MI) and all-cause mortality. Quantitative data synthesis was performed using a random-effects model and heterogeneity was assessed using Q and I2statistics. RESULTS A total of five studies evaluating 1794 subjects were included. Overall, there was no significant difference on MI in patients with CACP on β-blocker versus no β-blocker (OR 1.36, 95% CI 0.68 to 2.75; p=0.39). Similarly, there was no significant difference in all-cause mortality in patients on β-blocker versus no β-blocker (OR 0.68, 95% CI 0.26 to 1.79; p=0.43). CONCLUSIONS In patients presenting with acute chest pain and underlying cocaine, β-blocker use does not appear to be associated with an increased risk of MI or all-cause mortality.
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Affiliation(s)
- Don Pham
- Department of Medicine, Division of Cardiovascular Medicine, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Addison
- Department of Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, USA
| | - Waleed Kayani
- Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Arunima Misra
- Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hani Jneid
- Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Medicine, Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Jon Resar
- Department of Medicine, Division of Cardiovascular Medicine, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nassir Lakkis
- Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mahboob Alam
- Department of Medicine, Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
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Walsh S, Bhopal R, Bhardwaj S, Misra A. 5.10-P20Urbanised South Asians' susceptibility to coronary heart disease: the high-heat food preparation hypothesis. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Walsh
- Edinburgh University, United Kingdom
| | - R Bhopal
- Edinburgh University, United Kingdom
| | - S Bhardwaj
- National Diabetes, Obesity and Cholesterol Diseases Foundation, (N-DOC), SDA, India
- Diabetes Foundation (India), SDA, India
- Center of Nutrition and Metabolic Research (C-NET), India
| | - A Misra
- National Diabetes, Obesity and Cholesterol Diseases Foundation, (N-DOC), SDA, India
- Diabetes Foundation (India), SDA, India
- Center of Nutrition and Metabolic Research (C-NET), India
- Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, India
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Patel S, Huang J, Wright K, Albihani S, Misra A, Zhou P, Jones B, Kimata J, Bollard C, Cruz R. HIV-specific T cells expressing an X5-GPI artificial receptor can suppress HIV replication in vitro—implications for a cure strategy for HIV+ individuals with hematologic malignancies. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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39
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Rai S, Bhardwaj U, Misra A, Singh S, Gupta R. Comparison between photostability of Alexa Fluor 448 and Alexa Fluor 647 with conventional dyes FITC and APC by flow cytometry. Int J Lab Hematol 2018; 40:e52-e54. [PMID: 29575796 DOI: 10.1111/ijlh.12809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S Rai
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - U Bhardwaj
- Maharaj Vinayak Global University, Jaipur, Rajasthan
| | - A Misra
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Singh
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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40
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Misra A, de Souza L, Illner M, Hohl L, Kraume M, Repke JU, Thévenin D. Simulating separation of a multiphase liquid-liquid system in a horizontal settler by CFD. Chem Eng Sci 2017. [DOI: 10.1016/j.ces.2017.03.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The prevalence of obesity in India is increasing and ranges from 8% to 38% in rural and 13% to 50% in urban areas. Obesity is a risk factor for development of type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease and many cancers. In Asian Indians excess abdominal and hepatic fat is associated with increased risk for T2DM and cardiovascular disease. There is higher risk for development of obesity related non-communicable diseases at lower body mass index levels, compared to white Caucasians. Despite being a commonly encountered medical problem, obesity poses challenges in treatment. Many Indian physicians find themselves to be lacking time and expertise to prepare an appropriate obesity management plan and patients experience continuous weight gain over time despite being under regular medical supervision. In this article, we outline approaches to obesity management in ‘real life mode’ and in context to Asian Indian patients.
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Affiliation(s)
- S Behl
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Allied Specialties, New Delhi, India.
| | - A Misra
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Allied Specialties, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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42
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Patel S, Wright K, Misra A, Zhou P, Kimata J, Bollard C, Cruz R. HIV specific t cells expressing an X5–GPI artificial receptor can suppress hiv replication in vitro— implications for a cure strategy for HIV+ individuals with hematologic malignancies. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Cunningham L, Misra A. Serelaxin in the Treatment of Acute Heart Failure in the Emergency Department. Curr Emerg Hosp Med Rep 2017. [DOI: 10.1007/s40138-017-0136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Misra A. Initiating Kangaroo Mother Care in Facilities in Limited Resource
Settings. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Misra A, Chopra A, Kumar R, Bakhshi S. Diagnostic considerations in juvenile myelomonocytic leukemia in tropical settings. Int J Lab Hematol 2017; 39:e77-e79. [PMID: 28263030 DOI: 10.1111/ijlh.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Misra
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - A Chopra
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - R Kumar
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - S Bakhshi
- IRCH, Medical Oncology, AIIMS, New Delhi, India
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Asthana V, Sundararajan M, Karun V, Ackah R, Misra A, Pritchett A, Siler-Fisher A, Peacock WF. EDUCATIONAL STRATEGY FOR MANAGEMENT OF HEART FAILURE MARKEDLY REDUCES 90-DAY EMERGENCY DEPARTMENT AND HOSPITAL READMISSIONS IN UN- AND UNDERINSURED PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34169-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Pacheco AG, Salgado-Morán G, Gerli-Candia L, Ramírez-Tagle R, Glossman-Mitnik D, Misra A, de Carvalho Alcântara AF. Theoretical investigation of the molecular structure and spectroscopic properties of oxicams. J STRUCT CHEM+ 2017. [DOI: 10.1134/s0022476617020068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills AP, Misra A. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC Public Health 2017; 17:101. [PMID: 28109251 PMCID: PMC5251315 DOI: 10.1186/s12889-017-4041-1] [Citation(s) in RCA: 378] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background The Asia-Pacific region is home to nearly half of the world’s population. The region has seen a recent rapid increase in the prevalence of obesity, type-2 diabetes and cardiovascular disease. The present systematic review summarizes the recent prevalence and trends of Metabolic Syndrome (MetS) among adults in countries of the Asia-Pacific Region. Methods Data on MetS in Asia-Pacific countries were obtained using a stepwise process by searching the online Medline database using MeSH terms ‘Metabolic Syndrome X’ and ‘Epidemiology/EP’. For the purpose of describing prevalence data for the individual countries, studies that were most recent, nationally representative or with the largest sample size were included. When evaluating secular trends in prevalence in a country we only considered studies that evaluated the temporal change in prevalence between similar populations, prospective studies based on the same population or National surveys conducted during different time periods. Results This literature search yielded a total of 757 articles, and five additional article were identified by screening of reference lists. From this total, 18 studies were eligible to be included in the final analysis. Of the 51 Asia-Pacific countries (WHO) we only located data for 15. There was wide between country variation in prevalence of MetS. A national survey from Philippines conducted in 2003 revealed the lowest reported prevalence of 11.9% according to NCEP ATP III criteria. In contrast, the highest recorded prevalence in the region (49.0%) came from a study conducted in urban Pakistan (Karachchi, 2004). Most studies reported a higher prevalence of MetS in females and urban residents. Data on secular trends were available for China, South Korea and Taiwan. An increase in the prevalence of MetS was observed in all three countries. Conclusion Despite differences in methodology, diagnostic criteria and age of subjects studied, the Asia-Pacific region is facing a significant epidemic of MetS. In most countries nearly 1/5th of the adult population or more were affected by MetS with a secular increase in prevalence. Strategies aimed at primary prevention are required to ameliorate a further increase in the epidemic and for the reduction of the morbidity and mortality associated with MetS. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4041-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Y Mathangasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - R Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - A P Hills
- School of Health Sciences, Faculty of Health, University of Tasmania, Tasmania, Australia
| | - A Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
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Shrivastava U, Misra A, Mohan V, Unnikrishnan R, Bachani D. Obesity, Diabetes and Cardiovascular Diseases in India: Public Health Challenges. Curr Diabetes Rev 2017; 13:65-80. [PMID: 27515855 DOI: 10.2174/1573399812666160805153328] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/26/2016] [Accepted: 07/25/2016] [Indexed: 11/22/2022]
Abstract
Non-communicable diseases (NCDs; including coronary heart disease and type 2 diabetes) are rapidly increasing in India causing nearly 5.8 million deaths per year. Primary reasons for rise in NCDs in India are nutrition and lifestyle transitions. Further, presence of higher body fat, abdominal fat, liver and pancreatic fat and lower lean mass than whites, contribute to heightened metabolic and cardiovascular risk in Asian Indians. Importantly, conversion from pre-diabetes to diabetes occurs more rapidly, and reversion to normal glucose regulation with appropriate lifestyle measures is more difficult in Asian Indians than white population. Huge number of patients with diabetes and with complications increase morbidity, mortality and pose substantial economic burden. It is difficult, though not impossible, to decrease pace of rapidly expanding juggernaut of NCDs in India. Only concerted efforts from multiple stakeholders, consistently sincere efforts and intensely focused attention from health officialdom and clear political will may help counter this increasingly difficult challenge. Finally, all prevention and management approaches should be cost-effective, pragmatic, and focused on children and underprivileged populations.
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Affiliation(s)
| | - A Misra
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Endocrinology, B-16, Chirag Enclave, New Delhi, India
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Abstract
The vessel wall is composed of distinct cellular layers, yet communication among individual cells within and between layers results in a dynamic and versatile structure. The morphogenesis of the normal vascular wall involves a highly regulated process of cell proliferation, migration, and differentiation. The use of modern developmental biological and genetic approaches has markedly enriched our understanding of the molecular and cellular mechanisms underlying these developmental events. Additionally, the application of similar approaches to study diverse vascular diseases has resulted in paradigm-shifting insights into pathogenesis. Further investigations into the biology of vascular cells in development and disease promise to have major ramifications on therapeutic strategies to combat pathologies of the vasculature.
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Affiliation(s)
- R Mazurek
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - J M Dave
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - R R Chandran
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - A Misra
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - A Q Sheikh
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - D M Greif
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States.
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