Association of race and in-hospital outcomes following acute pulmonary embolism: A retrospective cohort study.

BACKGROUND: Racial disparities in health care are well established, with Black patients frequently experiencing the most significant consequences of this inequality. Acute pulmonary embolism (PE) is increasing in incidence and an important cause of morbidity and mortality in the United States, but little is known about racial disparities in the inpatient setting. HYPOTHESIS: Black and White patients admitted with acute PE will have different in-hospital outcomes. METHODS: All PE patients from January 1, 2016 to June 30, 2017 were retrospectively identified using ICD-10 codes. Data were abstracted by manual chart review for all image-confirmed PEs. RESULTS: A total of 782 patients with acute PE were identified, of which 319 (40.8%) were Black and 463 (59.2%) were White. Black patients had higher BMI (median [Q1-Q3]: 30.3 [25.4-36.6] vs. 29.3 [24.5-33.8] kg/m2 , p = .017), were younger (61 [48-74] vs. 67 [54-75] years, p = .001), and were more likely to have a history of heart failure (16.0 vs. 7.1%, p < .001), while White patients had higher rates of malignancy (46.9 vs. 34.5%, p = .001) and recent surgery (29.6 vs. 18.2%, p < .001). Black patients were more likely to receive systemic thrombolysis (3.1% vs. 1.1%, p = .040), while White patients had numerically higher rates of surgical embolectomy (0.3% vs. 1.1%, p = .41). No difference in inpatient mortality was observed; however, Black patients had longer hospital length of stay (5.0 [3-9] vs. 4.0 [2-9] days, p = .007) and were more likely to receive warfarin (23.5 vs. 12.1%, p < .001). CONCLUSIONS: Similar in-hospital mortality rates were observed in Black and White patients following acute PE. However, Black patients had longer hospital stays, higher warfarin prescription, and fewer traditional PE-related risk factors.

Effect of once-weekly exenatide on hospitalization for acute coronary syndrome or coronary revascularization in patients with type 2 diabetes mellitus.

Cardiovascular (CV) outcome studies of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shifted the paradigm of type 2 diabetes management given their benefits regarding a reduction in major adverse CV events. However, the relationship between GLP-1 RAs and coronary revascularization remains poorly understood. In this EXSCEL post-hoc analysis, we used univariate Cox proportional models and Kaplan Meier survival analysis to evaluate the effect of once-weekly exenatide (EQW) on a composite outcome of hospitalization for acute coronary syndrome (ACS) or coronary revascularization. Similar models were utilized to evaluate the relationship between significant participant characteristics within the entire study population and the composite outcome. Of the 14,736 participants in EXSCEL with complete follow-up data, 1642 (11.1%) experienced an ACS or coronary revascularization event during a median follow-up of 3.3 years (interquartile range, 2.3-4.4). EQW had no effect on hospitalization for ACS or coronary revascularization (HR 1.00, 95% CI 0.91-1.10). Among EXSCEL participants, enrollment in Latin America (HR 0.51, 95% CI 0.43-0.60) and a history of peripheral artery disease (HR 0.79, 95% CI 0.70-0.90) were associated with a reduced risk for coronary revascularization, whereas enrollment in North America (HR 1.92, 95% CI 1.74-2.12), a history of CV disease (HR 3.24, 95% CI 2.78-3.78), and a previous myocardial infarction (HR 1.54, 95% CI 1.39-1.71) were associated with increased risk for study end points. EQW had no association with hospitalization for ACS or coronary revascularization. Participant enrollment location and CV disease burden may play a role in the variable CV efficacy of GLP-1 RAs that has been observed in trials thus far.

Alterations in microRNA expression in a murine model of diet-induced vasculogenic erectile dysfunction.

INTRODUCTION: MicroRNAs (miRs) are noncoding, endogenous RNA molecules that regulate gene expression and play roles in response to vascular injury. AIM: The aim of this study was to identify miRs expressed in corporal tissue (CT) and to determine whether miRs demonstrate differential expression in a mouse model of diet-induced erectile dysfunction (ED). METHODS: RNA was isolated from the CT from control mice and mice with diet-induced ED. A quantifiable miR profiling technique (NanoString) was used to determine the expression of over 600 miRs. MAIN OUTCOME MEASURES: Differential expression analysis was performed using a negative binomial regression model for count-based data. Mean expression levels, fold change, and false discovery-corrected P values were determined. Candidate miRs were validated via quantitative polymerase chain reaction (Q-PCR). RESULTS: In control mice, NanoString analysis revealed that 181 miRs were expressed above background levels and 5 miRs were expressed at high levels. Diet-induced ED resulted in the up-regulation of 6 miRs and the down-regulation of 65 miRs in the CT compared with mice on control diet. Focusing on the upregulated miRs, we chose five for Q-PCR validation. Of these five, two (miR-151-5p and miR-1937c) demonstrated significance via Q-PCR, whereas the other three (miR-720, miR-1937a, miR-205) trended in the correct direction. CONCLUSIONS: MiRs may play a significant role in mRNA regulation in CT and specific miRs may be involved in diet-induced vasculogenic ED. Future studies are aimed at determining the mRNA targets of these miRs.