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Satish P, Avenatti E, Patel J, Agarwala A. Understanding the spectrum of cardiovascular risk in women - A primer for prevention. Prog Cardiovasc Dis 2024:S0033-0620(24)00070-7. [PMID: 38710313 DOI: 10.1016/j.pcad.2024.05.003] [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: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.
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Affiliation(s)
- Priyanka Satish
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Eleonora Avenatti
- Center for Cardiovascular Prevention, Ascension Texas Cardiovascular, Dell Medical School, University of Texas, Austin, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA.
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Satish P, Khetan A, Shah D, Srinivasan S, Balakrishnan R, Padmanandan A, Hejjaji V, Hull L, Samuel R, Josephson R. Response to Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco. J Gen Intern Med 2024; 39:1075. [PMID: 37723365 DOI: 10.1007/s11606-023-08413-y] [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] [Indexed: 09/20/2023]
Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Aditya Khetan
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | | | - Shuba Srinivasan
- Department of General Medicine, Satya Sai Sarala Memorial hospital, Mahavalli, Karnataka, India
| | - Rojith Balakrishnan
- Department of Medicine, Government Calicut Medical College, Calicut, Kerala, India
| | - Arun Padmanandan
- Ministry of Health and Family Welfare, Senior Zonal AEFI Consultant, Govt of India, New Delhi, India
| | - Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Kaur G, Masket D, Reddy T, Revankar S, Satish P, Paquin A, Mulvagh S, O'Donoghue ML, Zieroth S, Farkouh M, Gulati M. Socioeconomic Disparities in Women's Cardiovascular Health in the United States and Canada. Can J Cardiol 2024:S0828-282X(24)00295-2. [PMID: 38593915 DOI: 10.1016/j.cjca.2024.04.001] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular disease has been the leading cause of death in the United States and Canada for decades. Although it affects millions of people across a multitude of backgrounds, notable disparities in cardiovascular health are observed among women and become more apparent when accounting for race and socioeconomic status. Although intrinsic sex-specific physiologic differences predispose women to poorer outcomes, social determinants of health (SDOH) and biases at both the individual provider and the larger health care system levels play an equal, if not greater, role. This review examines socioeconomic disparities in women compared with men regarding cardiovascular risk factors, treatments, and outcomes. Although various at-risk subpopulations exist, we highlight the impact of SDOH in specific populations, including patients with disabilities, transgender persons, and South Asian and Indigenous populations. These groups are underrepresented in studies and experience poorer health outcomes owing to structural barriers to care. These findings emphasise the significance of understanding the interplay of different socioeconomic factors and how their stacking can negatively affect women's cardiovascular health. To address these disparities, we propose a multipronged approach to augment culturally sensitive and patient-centred care. This includes increased cardiovascular workforce diversity, inclusion of underrepresented populations into analyses of cardiovascular metrics, and greater utilisation of technology and telemedicine to improve access to health care. Achieving this goal will necessitate active participation from patients, health care administrators, physicians, and policy makers, and is imperative in closing the cardiovascular health gap for women over the coming decades.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diane Masket
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Tina Reddy
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shruti Revankar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Priyanka Satish
- Ascension Texas Cardiovascular, University of Texas at Austin Dell School of Medicine, Austin, Texas, USA
| | - Amelie Paquin
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelley Zieroth
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Farkouh
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
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Revankar S, Park JK, Satish P, Agarwala A. Is there a role for earlier use of combination therapy? Am J Prev Cardiol 2024; 17:100639. [PMID: 38419948 PMCID: PMC10900258 DOI: 10.1016/j.ajpc.2024.100639] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
As the global population ages and cardiovascular risk factors rise, we can expect a continued increase in atherosclerotic disease. Low-density lipoprotein cholesterol (LDL-C) reduction is a cornerstone of cardiovascular risk reduction with strong, causal evidence indicating that the greatest benefit is derived from early and large decreases in LDL-C. Despite the adoption of statins as the backbone of lipid-therapy regimens, numerous studies and registry analyses reveal our collective inability to achieve LDL-C goals in high-risk patients. Combination therapy with ezetimibe has been shown to result in statistically significant decreases in LDL-C level, atheroma volume, and cardiovascular adverse event rates. A major barrier to implementing an upfront combination therapy approach is the perceived side effects from therapeutic agents although multiple studies show that a therapeutic patient-physician relationship could overcome this issue. Novel agents such as PCSK-9 inhibitors, bempedoic acid, and inclisiran have the potential to achieve similar outcomes although additional research is needed regarding the cost effectiveness of these approaches. Despite these hurdles, there is a role for the newer agents early in the disease course of high-risk patients such as those with markedly elevated LDL-C >190 mg/dL and FH. The implementation of upfront combination therapy, especially in high-risk patients, will decrease clinical inertia while allowing for earlier consideration of newer, effective agents to decrease cardiovascular burden.
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Affiliation(s)
- Shruti Revankar
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jong Kun Park
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Priyanka Satish
- The University of Texas at Austin Dell School of Medicine, Ascension Texas Cardiovascular, Austin, TX, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA
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Satish P, Khetan A, Shah D, Srinivasan S, Balakrishnan R, Padmanandan A, Hejjaji V, Hull L, Samuel R, Josephson R. Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial. J Gen Intern Med 2023; 38:3162-3170. [PMID: 37286774 PMCID: PMC10247264 DOI: 10.1007/s11606-023-08243-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings. OBJECTIVE We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling. DESIGN Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India. PARTICIPANTS Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking. INTERVENTION A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge. MAIN MEASURES The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training. KEY RESULTS Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001). CONCLUSIONS Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates. TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov . Unique identifier: NCT03521466.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Aditya Khetan
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | | | - Shuba Srinivasan
- Department of General Medicine, SMSIMSR, Muddenahalli, Karnataka, India
| | | | - Arun Padmanandan
- Senior Zonal AEFI Consultant, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Hatab T, Bou Chaaya RG, Zaid S, Wessly P, Satish P, Villanueva V, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Feasibility and Outcomes of Mitral Transcatheter Edge-To-Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification. J Am Heart Assoc 2023; 12:e031118. [PMID: 37753800 PMCID: PMC10727232 DOI: 10.1161/jaha.123.031118] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge-to-edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge-to-edge repair. Methods and Results We reviewed the records of 280 patients with moderate-severe or severe mitral regurgitation who underwent mitral transcatheter edge-to-edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow-up was 23.1 months (interquartile range: 11.1-40.4). Procedural success was comparable in the MAC and non-MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1-year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27-3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10-4.41], P=0.02; and HR, 1.014 [1.006-1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1-year mortality and less improvement in their symptoms after TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Marvin D. Atkins
- Department of Cardiovascular SurgeryHouston Methodist HospitalHoustonTX
| | | | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
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Taha MB, Javed Z, Nwana N, Acquah I, Satish P, Sharma G, Sabouret P, Cainzos-Achirica M, Nasir K. Body Mass Index and All-Cause and Cardiovascular Mortality in United States Adults With and Without Atherosclerotic Cardiovascular Disease: Findings from the National Health Interview Survey. Popul Health Manag 2023; 26:254-267. [PMID: 37590068 DOI: 10.1089/pop.2022.0280] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
In a nationally representative population-based study of US adults, the authors sought to examine the association between body mass index (BMI) and all-cause and cardiovascular disease (CVD) mortality in a nationally representative sample of adults with and without atherosclerotic cardiovascular disease (ASCVD), and further stratified by age, sex, and race/ethnicity. The study used data from 2006 to 2015 National Health Interview Survey and categorized participants into the following BMI categories: normal weight (20-24.9), overweight (25-29.9), obesity class 1 (30-34.9), obesity class 2 (35-39.9), and obesity class 3 (≥40 kg/m2). Multivariable Cox proportional hazards models were used to assess the risk of all-cause and CVD mortality across successively increasing BMI categories overall, and by sociodemographic subgroups. A total of 210,923 individuals were included in the final analysis. In the population without ASCVD, the risk of all-cause and CVD mortality was lower in overweight and higher in obesity classes 2 and 3, compared with normal weight, with the highest risk observed in the young adult (age 18-39) population. Elderly adults (65 and above) and populations with ASCVD exhibited a BMI-mortality paradox. In addition, Hispanic individuals did not show a relationship between BMI and mortality compared with non-Hispanic White and Black adults. In conclusion, being overweight was associated with decreased risk, whereas obesity class 3 was consistently associated with increased risk of all-cause and CVD mortality in adults without ASCVD, particularly young adults. BMI-mortality paradox was noted in ASCVD, elderly, and non-Hispanic adults.
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Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Nwabunie Nwana
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Isaac Acquah
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pierre Sabouret
- Department of Cardiology, Heart Institute, Pitié Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
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Satish P, Rosser C, Khoshnevis G, Shah DJ, Fida N. A STRONG INFECTION AND A WEAK HEART. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03945-1] [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: 03/06/2023]
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Agarwala A, Satish P, Rifai MA, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC Adv 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Nwana N, Taha MB, Javed Z, Gullapelli R, Nicolas JC, Jones SL, Acquah I, Khan S, Satish P, Mahajan S, Cainzos-Achirica M, Nasir K. Neighborhood deprivation and morbid obesity: Insights from the Houston Methodist Cardiovascular Disease Health System Learning Registry. Prev Med Rep 2022; 31:102100. [PMID: 36820380 PMCID: PMC9938328 DOI: 10.1016/j.pmedr.2022.102100] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
This study examined the relationship between a validated measure of socioeconomic deprivation, such as the Area Deprivation Index (ADI), and morbid obesity. We used cross-sectional data on adult patients (≥18 years) in the Houston Methodist Cardiovascular Disease Health System Learning Registry (located in Houston, Texas, USA) between June 2016 and July 2021. Each patient was grouped by quintiles of ADI, with higher quintiles signaling greater deprivation. BMI was calculated using measured height and weight with morbid obesity defined as ≥ 40 kg/m2. Multivariable logistic regression models were used to examine the association between ADI and morbid obesity adjusting for demographic (age, sex, and race/ethnicity) factors. Out of the 751,174 adults with an ADI ranking included in the analysis, 6.9 % had morbid obesity (n = 51,609). Patients in the highest ADI quintile had a higher age-adjusted prevalence (10.9 % vs 3.3 %), and about 4-fold odds (aOR, 3.8; 95 % CI = 3.6, 3.9) of morbid obesity compared to the lowest ADI quintile. We tested for and found interaction effects between ADI and each demographic factor, with stronger ADI-morbid obesity association observed for patients that were female, Hispanic, non-Hispanic White and 40-65 years old. The highest ADI quintile also had a high prevalence (44 %) of any obesity (aOR, 2.2; 95 % CI = 2.1, 2.2). In geospatial mapping, areas with higher ADI were more likely to have higher proportion of patients with morbid obesity. Census-based measures, like the ADI, may be informative for area-level obesity reduction strategies as it can help identify neighborhoods at high odds of having patients with morbid obesity.
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Key Words
- ADI, Area Deprivation Index
- BMI, Body Mass Index
- CA, Catchment Area
- CI, Confidence Interval
- CVD, Cardiovascular Diseases
- Data-driven
- ED, Emergency Department
- FIPS, Federal Information Processing Standards
- HM, Houston Methodist
- Health equity
- IRB, Internal Review Board
- Morbid obesity
- Neighborhood deprivation
- OR, Odds Ratio
- SD, Standard Deviation
- SDOH, Social Determinants of Health
- SES, Socio-Economic Status
- US, United States
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Affiliation(s)
- Nwabunie Nwana
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamad B. Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Rakesh Gullapelli
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Juan C. Nicolas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Stephen L. Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Safi Khan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Priyanka Satish
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shivani Mahajan
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA,Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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11
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Narasimhan B, Aggarwal D, Satish P, Kantharia B, Aronow WS. Postural orthostatic tachycardia syndrome: pathophysiology, management, and experimental therapies. Expert Opin Investig Drugs 2022; 31:1017-1025. [PMID: 36094001 DOI: 10.1080/13543784.2022.2121697] [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: 11/04/2022]
Affiliation(s)
- Bharat Narasimhan
- Department of Cardiology, Houston Methodist Debakey Cardiovascular Center, Houston, Tx, USA
| | - Devika Aggarwal
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Priyanka Satish
- Department of Cardiology, Houston Methodist Debakey Cardiovascular Center, Houston, Tx, USA
| | - Bharat Kantharia
- Cardiovascular and Heart Rhythm Consultants, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical center/New York Medical College, Valhalla, NY, USA
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12
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Bays HE, Kulkarni A, German C, Satish P, Iluyomade A, Dudum R, Thakkar A, Rifai MA, Mehta A, Thobani A, Al-Saiegh Y, Nelson AJ, Sheth S, Toth PP. Ten things to know about ten cardiovascular disease risk factors - 2022. Am J Prev Cardiol 2022; 10:100342. [PMID: 35517870 PMCID: PMC9061634 DOI: 10.1016/j.ajpc.2022.100342] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 12/11/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
The American Society for Preventive Cardiology (ASPC) "Ten things to know about ten cardiovascular disease risk factors - 2022" is a summary document regarding cardiovascular disease (CVD) risk factors. This 2022 update provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of prior annual versions of "Ten things to know about ten cardiovascular disease risk factors" published since 2020. This 2022 version provides the perspective of ASPC members and includes updated sentinel references (i.e., applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the ASPC "Ten things to know about ten cardiovascular disease risk factors - 2022" to provide a tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide ready access to applicable guidelines and sentinel reviews.
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Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville KY 40213
| | - Anandita Kulkarni
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701
| | - Charles German
- University of Chicago, Section of Cardiology, 5841 South Maryland Ave, MC 6080, Chicago, IL 60637
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA 77030
| | - Adedapo Iluyomade
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL 33176
| | - Ramzi Dudum
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Aarti Thakkar
- Osler Medicine Program, Johns Hopkins Hospital, Baltimore MD
| | | | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Thobani
- Emory University School of Medicine | Department of Cardiology, 101 Woodruff Circle, WMB 2125, Atlanta, GA 30322
| | - Yousif Al-Saiegh
- Lankenau Medical Center – Mainline Health, Department of Cardiovascular Disease, 100 E Lancaster Ave, Wynnewood, PA 19096
| | - Adam J Nelson
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX 75093
| | - Samip Sheth
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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13
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Satish P, Vela E, Bilal U, Cleries M, Kanaya AM, Kandula N, Virani SS, Islam N, Valero-Elizondo J, Yahya T, Comin-Colet J, Nasir K, Mauri J, Cainzos-Achirica M. Burden of cardiovascular risk factors and disease in five Asian groups in Catalonia: a disaggregated, population-based analysis of 121 000 first-generation Asian immigrants. Eur J Prev Cardiol 2022; 29:916-924. [PMID: 33969397 PMCID: PMC9793716 DOI: 10.1093/eurjpc/zwab074] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022]
Abstract
AIMS To evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese. METHODS AND RESULTS Retrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals ('locals'). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD. CONCLUSIONS In Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.
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Affiliation(s)
- Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA 19104, USA
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Alka M. Kanaya
- Department of Medicine, University of California, San Francisco (CA), 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Namratha Kandula
- Feinberg School of Medicine, Northwestern University, Chicago(IL), 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Nadia Islam
- Department of Population Health, NYU Langone Health, 550 1st Avenue, New York, NY 10016, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josep Comin-Colet
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josepa Mauri
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA,Corresponding author. Tel: +1 443 413 6350,
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14
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Satish P, Bhimaraj A, Al-Mallah M. AN UNUSUAL CAUSE OF CHEST PAIN: EXTRINSIC COMPRESSION OF THE CORONARY ARTERIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03956-0] [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: 11/25/2022]
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15
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Bhatia R, Padma Srivastava MV, Sylaja PN, Komakula S, Upadhyay A, Pardasani V, Iype T, Parthasarathy R, Reddy R, Kushwaha S, Roy J, Satish P, Trikha A, Wig N, Dhar L, Vibha D, Vishnu VY, Pandit AK, Gupta A, Elavarasi A, Agarwal A, Gupta V, Singh RK, Oza H, Halani H, Ramachandran D, George GB, Panicker P, Suresh MK, Kumaravelu S, Khurana D, Rajendran SP, Pamidimukkala V, Gupta S, Pandian JD, Chowdhury D, Rai NK, Sharma A, Nambiar VK. Clinical Features and Outcome of Stroke with COVID-19. COVID-19 Stroke Study Group (CSSG), India. Ann Indian Acad Neurol 2022; 24:668-685. [PMID: 35002124 PMCID: PMC8680894 DOI: 10.4103/aian.aian_122_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/07/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: Occurrence of stroke has been reported among patients with COVID-19. The present study compares clinical features and outcomes of stroke patients with and without COVID-19. Methods: The COVID-19 Stroke Study Group (CSSG) is a multicentric study in 18 sites across India to observe and compare the clinical characteristics of patients with stroke admitted during the current pandemic period and a similar epoch in 2019. The present study reports patients of stroke with and without COVID-19 (CoVS and non-CoVS, respectively) seen between February 2020 and July 2020. Demographic, clinical, treatment, and outcome details of patients were collected. Results: The mean age and gender were comparable between the two groups. CoVS patients had higher stroke severity and extent of cerebral involvement on imaging. In-hospital complications and death were higher among CoVS patients (53.06% vs. 17.51%; P < 0.001) and (42.31% vs. 7.6%; P < 0.001), respectively. At 3 months, higher mortality was observed among CoVS patients (67.65% vs. 13.43%; P < 0.001) and good outcome (modified Rankin score [mRS]: 0–2) was seen more often in non-CoVS patients (68.86% vs. 33.33%; P < 0.001). The presence of COVID-19 and baseline stroke severity were independent predictors of mortality. Conclusions: CoVS is associated with higher severity, poor outcome, and increased mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and baseline stroke severity are independent predictors of mortality.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vibhor Pardasani
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Thomas Iype
- Department of Neurology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Rajsrinivas Parthasarathy
- Department of Neurology, Artemis Hospitals, Gurgaon, Haryana, India.,Department of Neurointervention Surgery, Artemis Hospitals, Gurgaon, Haryana, India
| | - Rajshekhar Reddy
- Department of Neurology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Neurology, New Delhi, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - P Satish
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Dhar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishore Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A Elavarasi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vipul Gupta
- Department of Neurointervention Surgery, Artemis Hospitals, Gurgaon, Haryana, India
| | - Rakesh K Singh
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Harsh Oza
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Hiral Halani
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Dileep Ramachandran
- Department of Neurology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Githin B George
- Department of Neurology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Praveen Panicker
- Department of Neurology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - M K Suresh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumaravelu
- Department of Neurology, Ramesh Hospitals Guntur, Andhra Pradesh, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Vijaya Pamidimukkala
- Department of Neurology, Lalitha Super Specialty Hospital, Guntur, Andhra Pradesh, India
| | - Salil Gupta
- Department of Neurology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Debashish Chowdhury
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi, India
| | - Nirendra K Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arvind Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Vivek K Nambiar
- Department of Neurology, Amrita Institute of Medical Sciences, Cochin, Kerala
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16
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Nguyen RT, Satish P, Atkins MD, Goel SS. An Undiagnosed Ventricular Septal Rupture Presenting as New Onset Heart Failure: A Rare Complication of an Anterior Myocardial Infarction. Methodist Debakey Cardiovasc J 2022; 18:113-116. [PMID: 36561850 PMCID: PMC9733135 DOI: 10.14797/mdcvj.1157] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Ventricular septal ruptures (VSR) are a rare but fatal complication of acute myocardial infarctions. We present a patient complaining of new onset heart failure symptoms that were found to be secondary to a new ventricular septal rupture from a recently undiagnosed anterior myocardial infarction. The patient underwent successful VSR patch repair with eventual recovery. This case highlights the importance of early diagnosis of VSR and reviews management options and appropriate timing for intervention.
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17
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Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, Virani S, Cainzos-Achirica M, Nasir K. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol 2021; 7:100219. [PMID: 34611645 PMCID: PMC8387290 DOI: 10.1016/j.ajpc.2021.100219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. METHODS : Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. RESULTS : Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. CONCLUSION : We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Murrium I. Sadaf
- Yale New Haven Medical Center (Waterbury) Internal Medicine Residency Program, Waterbury, CT, United States
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Gowtham R. Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Hassan Zawahir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Reed Mszar
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, CT, United States
| | - Bashir Hanif
- Dean, Faculty of Cardiology, College of Physicians and Surgeons Pakistan (CPSP), Pakistan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, United States
| | - Salim Virani
- Section of Cardiovascular Research, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
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18
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Bhugra P, Grandhi GR, Mszar R, Satish P, Singh R, Blaha M, Blankstein R, Virani SS, Cainzos-Achirica M, Nasir K. Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement. J Am Heart Assoc 2021; 10:e019671. [PMID: 34315229 PMCID: PMC8475658 DOI: 10.1161/jaha.120.019671] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.
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Affiliation(s)
| | | | - Reed Mszar
- Center for Outcomes Research and EvaluationYale New Haven Health New Haven CT
| | - Priyanka Satish
- Department of CardiologyHouston Methodist Hospital Houston TX
| | - Rahul Singh
- Department of Internal Medicine Houston Methodist Hospital Houston TX
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease Baltimore MD
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center Houston TX.,Baylor College of Medicine Houston TX
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Department of CardiologyHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Yale University New Haven CT
| | - Khurram Nasir
- Division Health Equity & Disparities Research Center for Outcomes Research Houston Methodist Hospital Houston TX.,Division of Cardiovascular Prevention and Wellness Department of Cardiovascular MedicineHouston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Cardiovascular Computational & Precision Health (C3-PH) Department of Cardiovascular Medicine Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Division of Cardiology Yale University New Haven CT
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Satish P, Kuusk T, Campain N, Abu-Ghanem Y, Neves J, Barod R, El-Sheikh S, Mumtaz F, Patki P, Tran M, Tran-Dang M, Grant L, Klatte T, Bex A. European Association of Urology COVID intermediate prioritisation group is poorly predictive of pathological high-risk among patients with renal tumours. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00996-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Satish P, Freeman A, Kelly D, Kirkham A, Orczyk C, Simpson B, Giganti F, Whitaker H, Emberton M, Norris J. Prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: A systematic review and meta-analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01283-5] [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: 10/20/2022]
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21
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Satish P, Khetan A, Raithatha S, Bhende P, Josephson R. Response to letter by Visaria et al regarding our article, “Standardizing hypertension management in a primary care setting in India through a protocol based model.”. Indian Heart J 2020; 72:59-60. [PMID: 32423564 PMCID: PMC7231870 DOI: 10.1016/j.ihj.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
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22
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Satish P, Khetan A, Barbhaya D, Agarwal M, Madan Mohan SK, Josephson R, Webel AR. A qualitative study of facilitators and barriers to cardiovascular risk factor control in a semiurban population in India. J Family Med Prim Care 2019; 8:3773-3778. [PMID: 31879612 PMCID: PMC6924214 DOI: 10.4103/jfmpc.jfmpc_492_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/23/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Dweep Barbhaya
- Department of Pharmacology, Seth G S Medical College, Mumbai, Maharashtra, India
| | - Manyoo Agarwal
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sri Krishna Madan Mohan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44122, USA
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Satish P, Khetan A, Raithatha S, Bhende P, Josephson R. Standardizing hypertension management in a primary care setting in India through a protocol based model. Indian Heart J 2019; 71:375-380. [PMID: 32035519 PMCID: PMC7013193 DOI: 10.1016/j.ihj.2019.11.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/26/2019] [Accepted: 11/16/2019] [Indexed: 01/13/2023] Open
Abstract
Hypertension is a leading cause of death in India. Control rates of hypertension are abysmal, even for people on treatment. There are a number of barriers to adequate control of hypertension in India, including therapeutic inertia and the lack of a systematic, simplified approach. Standardizing hypertension management through an evidence based model that sets thresholds for diagnosis, treatment goals, follow up intervals and choice of drugs can lead to improved management of hypertension in an individual hospital or health system. In this paper, we summarize the evidence for such a model, and adapt it to the Indian context, focusing on maximizing effectiveness, safety and ease of use by a non-expert. This model can be utilized by individual practitioners, hospitals, primary health centers (PHCs) and the Health and Wellness Centers (HWCs) under the Ayushman Bharat initiative.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
| | - Shyamsundar Raithatha
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Punam Bhende
- Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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24
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Satish P, Mohite B, Koli S. Bacterial exopolysaccharide: A smart biomaterial to address the heavy metal stress. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.059] [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: 10/28/2022]
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25
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Barbhaya D, Satish P, Khetan A, Madan Mohan SK, Josephson R, Webel A. Abstract 169: Knowledge, Attitude and Behaviors Influencing the Control of Hypertension and Diabetes: A Quantitative Study From India. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.169] [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: 11/16/2022]
Abstract
Background:
Approximately 75% of the mortality and morbidity in low and middle-income countries (LMIC) are from non-communicable diseases (NCDs), with cardiovascular diseases (CVD) accounting for nearly 50% of this burden. This is driven, in part, by suboptimal control of hypertension and diabetes. Yet before designing culturally-appropriate self-management interventions to decrease this burden, we must first understand the reasons why hypertension and diabetes is poorly controlled.
Methods:
Project SEHAT is a cluster randomized controlled trial investigating the effect of a community health worker-led program to control hypertension, diabetes and smoking in a semi urban community in West Bengal, India. Seventy- eight participants with hypertension and/or diabetes between 35-70 years of age were enrolled and stratified on gender, medication adherence level, and whether they had seen a physician. Focus group discussions were conducted to examine behavioral factors affecting hypertension and diabetes self-management. All focus groups were digitally recorded and wo coders independently coded the data. Qualitative description was used to analyze the data.
Results:
Most patients and their family members were concerned about their hypertension or diabetes. However, only 26% (6/23) of interviewed patients recognized that they were at increased risk for a CVD event. A majority (72% - 23/32) claimed they were unable to adhere to their medications, often because of cost. Participants did not engage in healthy lifestyle behaviors (i.e., diet and exercise) and were unaware of these interventions. Approximately, 80% (40/50) visited modern physician while 10% (5/50) visited informal health practitioners, usually for financial reasons.
Discussion:
There is a gap in knowledge about how to prevent CVD, even as most patients expressed concern about it. Poor insight into the disease process, belief in traditional practices, and competing financial needs were significant barriers to adopting healthy lifestyle behaviors. Intervention models should consider the existing level of knowledge and work with local traditions in order to improve self-management among those with hypertension and diabetes in this community.
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Affiliation(s)
| | | | - Aditya Khetan
- Harrington Heart and Vascular Cntr, Case Western Reserve Univ, Cleveland, OH
| | | | - Richard Josephson
- Harrington Heart and Vascular Cntr, Case Western Reserve Univ, Cleveland, OH
| | - Allison Webel
- Frances Payne Bolton Sch of Nursing, Case Western Reserve Univ, Cleveland, OH
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26
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Manjila S, Alambyan V, Singh G, Satish P, Geertman RT. From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926-2010) at Case Western Reserve University of Cleveland. World Neurosurg 2018; 113:14-25. [PMID: 29408298 DOI: 10.1016/j.wneu.2018.01.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/07/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Abstract
Dr. Robert J. White (1926-2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis.
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Affiliation(s)
- Sunil Manjila
- Department of Neurosurgery, McLaren Bay Region Hospital, Michigan, USA.
| | - Vilakshan Alambyan
- Department of Neurosurgery, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Gagandeep Singh
- Department of Neurosurgery, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Priyanka Satish
- Department of Neurosurgery, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Robert T Geertman
- Department of Neurosurgery, Metro Health Medical Center, Cleveland, Ohio, USA
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Abdulsalam MS, Ganapathy V, Satish P, Janakiraman RK, Singh S. Cystic Pheochromocytoma Presenting as Adrenal Cyst. J Clin Diagn Res 2017; 10:OD09-OD10. [PMID: 28050427 DOI: 10.7860/jcdr/2016/20129.8892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/16/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022]
Abstract
Pheochromocytomas are usually solid tumours. But it can present as cystic lesions in the adrenal gland. Cystic lesions in adrenal gland with hypertension needs attention to rule out pheochromocytoma. If ignored, it may lead to hypertensive emergency, multisystem crisis and death. Early diagnosis with biochemistry, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) of abdomen, proper functional imaging like Meta Iodo Benzyl Guanidine (MIBG) scan is essential. Proper preoperative preparation is important to prevent hypertensive crisis during and after surgery. We are reporting a case of cystic pheochromocytoma in a young male.
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Affiliation(s)
- Mohammed Shafi Abdulsalam
- Postgraduate Student, Department of General Medicine, Apollo Main Hospital , Chennai, Tamilnadu, India
| | - Vijaya Ganapathy
- Senior Consultant Endocrinologist, Apollo Main Hospital , Chennai, Tamilnadu, India
| | - Priyanka Satish
- Student, Stanley Medical College , Chennai, Tamilnadu, India
| | | | - Shivshankar Singh
- Senior Medical Specialist, GB Pant Hospital , Port Blair, Andaman and Nicobar Islands, India
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Satish P, Muralikrishnan K, Balasubramanian K. Heart rate variability changes during stroop color and word test among genders. Indian J Physiol Pharmacol 2015; 59:9-15. [PMID: 26571978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stress is the reaction of the body to a change that requires physical, mental or emotional adjustments. Individual differences in stress reactivity are a potentially important risk factor for gender-specific health problems in men and women. The Autonomic regulation of the cardiovascular system is most commonly affected by stress and is assessed by means of short term heart rate variability (HRV).The present study was undertaken to investigate the difference in the cardiovascular Autonomic Nervous System response to mental stress between the genders using HRV as tool. We compared the mean RR interval, Blood pressure and indices of HRV during the StroopColor Word Test (SCWT).Twenty five male (Age 19.52±0.714, BMI 22.73±2 kg/m2) and twenty five female subjects (Age 19.80±0.65, BMI 22.39±1.9) performed SCWT for five minutes. Blood Pressure (SBP p<0.01, DBP p<0.042) & Mean HR (p<0.010) values showed statistically significant difference among the genders. HRV indices like LFms2 (p<0.051), HF nu (p<0.029) and LF/HF ratio (p<0.025, p<0.052) show statistically significant difference among the genders. The response by the cardiovascular system to a simple mental stressor exhibits difference among the genders.
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29
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Kumar RR, Ramanappa MV, Satish P. Radiological quiz - musculoskeletal. Indian J Radiol Imaging 2006. [DOI: 10.4103/0971-3026.32391] [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: 11/04/2022] Open
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30
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Keshavan MS, David AS, Narayanen HS, Satish P. "On-off" phenomena and manic-depressive mood shifts: case report. J Clin Psychiatry 1986; 47:93-4. [PMID: 3944072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A patient with idiopathic Parkinson's disease and "on-off" phenomena is described. A consistent relationship existed between the "on" (dyskinetic) phases and mania and between the "off" (akinetic) phases and depression. The heuristic interest of this case and its indirect support of the dopamine hypothesis of affective disorder are discussed.
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Abstract
Fifteen cases of spinal arachnoiditis of noninfective etiology were treated with intrathecal hyaluronidase. In 10 patients, no obvious cause was evident; in four patients, arachnoiditis was the result of disk prolapse; and in one it followed spinal surgery. Fifteen hundred international units of hyaluronidase was injected intrathecally at intervals of 7-14 days. Four to nine injections (mean, 5.9) were given to each patient, and the patients were observed for 3-30 months (mean, 9.7). The effect of the treatment was assessed by the change in clinical grading from the pretreatment phase to the last examination. Satisfactory improvement was observed in 11 patients (73.3%) and "mild" recovery was observed in three patients. Because of this therapeutic efficacy and lack of serious toxic effects, intrathecally administered hyaluronidase appears to be of value in the management of spinal arachnoiditis.
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Gourie-Devi M, Satish P. Hyaluronidase as an adjuvant in the treatment of cranial arachnoiditis (hydrocephalus and optochiasmatic arachnoiditis) complicating tuberculous meningitis. Acta Neurol Scand 1980; 62:368-81. [PMID: 7468156 DOI: 10.1111/j.1600-0404.1980.tb03049.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Use of subarachnoid/intraventricular administration of hyaluronidase in the treatment of 15 cases of cranial arachnoiditis which occurred as a complication of tuberculous meningitis is reported. Eleven of these cases had communicating hydrocephalus and four had optochiasmatic arachnoiditis. An average of 4.5 injections were administered at weekly to fortnightly intervals. These patients had been followed-up for a mean period of 6.1 months per patient. Serious side effects such as flare-up of the underlying meningitis process, miliary spread of tuberculosis, convulsions or allergic reactions were not observed. Improvement of sensorium and/or neurological deficit was observed in 14 of the 15 cases. A clinically comparable group of 15 cases subjected to shunt surgery (14) and ventricular drainage (1) were considered as "control". This medical method of treatment appears to be superior to shunt surgery and offers a simpler alternative line of management of cranial arachnoiditis/hydrocephalus complicating tuberculous meningitis.
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Gourie-Devi M, Padmini R, Satish P. Use of intrathecal hyaluronidase in spinal arachnoiditis complicating tuberculous meningitis. Indian J Med Res 1980; 71:581-93. [PMID: 6893040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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