Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial.

Importance: The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. Objective: To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. Design, Setting, and Participants: This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Intervention: Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Main Outcomes and Measures: Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. Results: High- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). Conclusions and Relevance: The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT04047147.

Risk control and assessment of sulfide-rich sediment remediation by controlled-release calcium nitrate.

Nitrate stimulation is widely used in sediment remediation to eliminate sulfides, degrade organic pollutants and immobilize phosphorus. However, the environmental risks of nitrate escape and the subsequent release of pollutants (e.g. nitrite, ammonium and trace metals) to water bodies during its application has received less attention. In this study, controlled-release nitrate pellets (SedCaN pellets) were manufactured and applied at different sediment depths to examine their effectiveness in controlling the risk of nitrate escape and subsequent pollutant release. The germination of submerged plant was also analyzed to assess the ecological risks associated with the remediated sediment. The results showed that the SedCaN pellets slowly released calcium nitrate, which led to denitrifying sulfide oxidation, organic matter degradation and the immobilization of phosphorus as a calcium-bound species. Gas production by denitrification increased the sediment porosity (0.3-2.2%) and led to the concomitant release of nitrite, ammonium, and heavy metals, creating secondary risks. Application of the SedCaN pellets at depth decreased the nitrate escape and the secondary risks, presumably by means of a capping effect of the upper sediment. The release of nitrate, ammonium, Ni and Cu were partially limited by 91.6%, 19.0%, 61.6% and 57.4% when SedCaN pellets were incorporated into deeper sediments (7-9 cm). Moreover, the range of sulfide oxidation extended to the upper and lower sediments in the profile (column), while the sulfide oxidation efficiency reached 85.9-95.0%. Finally, increased germination of Bacopa monnieri (20.0-26%) demonstrated that in comparison to reference materials the ecological risks of the treated sediments was reduced and the habitat function of sediment was restored after nitrate-stimulating remediation. The results of this study provide valuable guidelines for nitrate-stimulating remediation of sulfide-rich (black-odor) sediments.

Emerging water pollution in the world's least disturbed lakes on Qinghai-Tibetan Plateau.

Qinghai-Tibet Plateau (QTP) Lake Region has largest abundance and size distribution of lakes in China. Being relatively away from major human activities, the water quality of these lakes has not attracted concerns in the past. However, dramatic climate change and intensified anthropogenic activities over the past 30 years have exerted multiple pressures on the water environment of the lakes, resulting in elevated nutrient concentrations in major freshwater lakes of the region. Rapid water quality deterioration and eutrophication of the lakes were first found in Lake Hurleg in the northeast of the plateau. Analyses of driving forces associated with these changes indicate that both the intrinsic characteristics of the QTP lakes and climate change were responsible for the vulnerability to human activities than other lakes in different regions of China, with accelerated urbanization and extensive economic development in the lake basin playing a decisive role in creating water pollution events. Under combination pressures from both natural and anthropogenic effect, the increasing rate of nutrient concentrations in Lake Hurleg has been 53-346 times faster than in Lake Taihu and Lake Dianchi during the deterioration stage. The result suggests the current development mode of Lake Hurleg basin is not suitable for setting protection targets for the QTP lake region more broadly due to its extremely poor environmental carrying capacity. To stop worsening the lake water environment condition, it is necessary to review the achievements made and lessons learned from China's fight against lake pollution and take immediate measures, inform policies into the development mode in the QTP lake region, and avoid irreversible consequences and ensure good water quality in the "Asian Water Tower."

Assessment of three essential tremor genetic loci in sporadic Parkinson's disease in Eastern China.

OBJECTIVE: The aim of this study was to investigate potential genetic overlap between essential tremor and Parkinson's disease in a cohort of 825 subjects from an Eastern Chinese population. METHODS: A total of 441 Parkinson's disease patients and 384 healthy controls were recruited. The MassARRAY System was used to detect three essential tremor-related single nucleotide polymorphisms. Odds ratio (OR) and 95% confidential interval (CI) were calculated to assess the relationship between polymorphisms and Parkinson's disease susceptibility. RESULTS: Our results demonstrated that the odds ratios of rs3794087 of SLC1A2, rs9652490 of LINGO1, and rs17590046 of PPARGC1A were 0.71 (95% CI = 0.55-0.91), 0.99 (95% CI = 0.78-1.26), and 0.88 (95% CI = 0.62-1.25), respectively. CONCLUSION: An essential tremor SNP (rs3794087 of SLC1A2) is associated with a decreased risk of PD in the Eastern Han Chinese population, while rs9652490 (LINGO1) and rs17590046 (PPARGC1A) do not show an association.

Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association.

BACKGROUND AND PURPOSE: Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD: The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS: The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS: The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.

Geographic Variations in Cardiovascular Disease Mortality Among Asian American Subgroups, 2003-2011.

BACKGROUND: There are well-documented geographical differences in cardiovascular disease (CVD) mortality for non-Hispanic whites. However, it remains unknown whether similar geographical variation in CVD mortality exists for Asian American subgroups. This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non-Hispanic whites. METHODS AND RESULTS: Using US death records from 2003 to 2011 (n=3 897 040 CVD deaths), age-adjusted CVD mortality rates per 100 000 population and age-adjusted mortality rate ratios were calculated for the 6 largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and compared with non-Hispanic whites. There were consistently lower mortality rates for all Asian American subgroups compared with non-Hispanic whites across divisions for CVD mortality and ischemic heart disease mortality. However, cerebrovascular disease mortality demonstrated substantial geographical differences by Asian American subgroup. There were a number of regional divisions where certain Asian American subgroups (Filipino and Japanese men, Korean and Vietnamese men and women) possessed no mortality advantage compared with non-Hispanic whites. The most striking geographical variation was with Filipino men (age-adjusted mortality rate ratio=1.18; 95% CI, 1.14-1.24) and Japanese men (age-adjusted mortality rate ratio=1.05; 95% CI: 1.00-1.11) in the Pacific division who had significantly higher cerebrovascular mortality than non-Hispanic whites. CONCLUSIONS: There was substantial geographical variation in Asian American subgroup mortality for cerebrovascular disease when compared with non-Hispanic whites. It deserves increased attention to prioritize prevention and treatment in the Pacific division where approximately 80% of Filipinos CVD deaths and 90% of Japanese CVD deaths occur in the United States.

Protective factors in American Indian communities and adolescent violence.

With their distinct cultural heritage and rural boundaries, American Indian reservation communities offer a unique opportunity to explore protective factors that help buffer adolescents from potential risk behaviors such as violence. Prior published research on Indian communities has not explored three potential protective factors for violence-parental monitoring of adolescents and friends, adolescents' self-efficacy to avoid fighting, and adolescents' interest in learning more about their traditional culture. This paper explores the relationship between these factors and reduced risk of reported violence. In 1998, 630 American Indian students in grades 6-12 were surveyed in five Midwestern, rural Indian reservation schools. Path analysis was used to identify the direct and indirect association of the three potential protective factors with reduced violence behavior. There were significant gender differences both in perceived parental monitoring and in adolescents' self-efficacy. For female adolescents, parental monitoring had the strongest inverse relationship with female adolescents' involvement in violence. Female adolescents' self-efficacy and their interest in learning more about their culture were also inversely associated with violence and therefore potentially important protectors. Male adolescents who reported more interest in learning the tribe's culture had better self-efficacy to avoid violence. However, self-efficacy did not successfully predict their reported involvement in peer violence. These findings support exploring gender differences, parental monitoring, self-efficacy training as well as cultural elements in future violence intervention studies. Further investigation is needed to identify protective factors for risk behaviors among male adolescents and test the generalizability to non-reservation based adolescents.