Coronary artery disease in South Asian immigrants living in New York City: angiographic findings and risk factor burdens.

BACKGROUND: The prevalence of coronary artery disease (CAD) among South Asians (SAs) significantly exceeds that of Caucasians. South Asians also suffer from more premature, clinically aggressive and angiographically extensive (3-vessel) disease. The role of conventional CAD risk factors (CCRFs) remains controversial. OBJECTIVES: We sought to determine if the CCRF burdens of SA immigrants differed from Caucasians. We also sought to determine whether angiographic CAD was more extensive among SAs and whether SA ethnicity was an independent predictor of 3-vessel disease. METHODS: We reviewed the CCRFs and angiograms of 520 SAs and 219 Caucasians consecutively referred with stable angina pectoris or acute coronary syndrome. RESULTS: Three-vessel CAD was significantly more common among SAs than Caucasians (32.5% vs 22.4%; P = .006). Diabetes mellitus (DM), age and male sex independently predicted 3-vessel disease. South Asian ethnicity showed a trend toward predicting 3-vessel disease (P = .06). The frequency of DM (55% vs 31.1%; P < .001), hypertension (77.5% vs 68.5%; P = .01), obesity (63.1% vs 44.3%; P < .001) and dyslipidemia (75.6% vs 61.6%; P < .001) were significantly greater among SAs; however, smoking was significantly more common among Caucasians (44.3% vs 21.3%; P < .001). Compared to Caucasians, SAs were significantly younger at the time of presentation for coronary angiography (58.5 vs 61.1 yrs; P = .001). CONCLUSIONS: SAs referred for coronary angiography with stable angina and acute coronary syndromes are younger, have significantly higher rates of 3-vessel disease, as well as higher rates of DM, hypertension, obesity and dyslipidemia than Caucasians. Aggressive screening, prevention and treatment may be warranted in this population.

Modeling digestion, absorption, and ketogenesis after administration of tricaprilin formulations to humans.

At present, tricaprilin is used as a ketogenic source for the management of mild to moderate Alzheimer's disease. After administration of the medium-chain triglyceride, tricaprilin is hydrolyzed to octanoic acid and further metabolized to ketones, acting as an alternative energy substrate for the brain. In this investigation, we developed a physiologically-based biopharmaceutics model simulating in vivo processes following the peroral administration of tricaprilin. The model includes multiple data sources to establish a partially verified framework for the simulation of plasma profiles. The input parameters were identified based on existing literature data and in vitro digestion studies. Model validation was conducted using the data from a phase I clinical trial. A partial parameter sensitivity analysis elucidated various influences on the plasma ketone levels that are mainly responsible for the therapeutic effects of tricaprilin. Based on our findings, we concluded that dispersibility and lipolysis of tricaprilin together with the gastric emptying patterns are limiting ketogenesis, while other steps such as the conversion of octanoic acid to ketone bodies play a minor role only.

Secrets of long life: cross-cultural explorations in sustainably enhancing vitality and promoting longevity via elders' practice wisdom.

In searching for different patterns of practice, lifestyle, and environment supportive of optimal health, we look to our elders around the world, who in the wisdom that has sustained them, we learn from with careful attention. Thirty-seven elders who live by their traditions participated in the present study. They assisted in the refinement of the methodology and collections and preparation of these data. These participants are well-respected, representative elders and traditional healers of their regions. These data, from study sites of the Eastern Afromontane and Albertine Rift region of Ethiopia, Africa; the Maya Mountains region of Belize, Central America; the Western Ghats region of India; and the Appalachian Mountains region of the United States, were grouped into three major categories: (1) philosophy, attitudes, and outlook, (2) lifestyle practices, and (3) dietary and nutritional practices. These elders demonstrate a relatively comprehensive but simple set of practices that can enhance our vitality and promote longevity sustainably. In essence, these practices, or practice wisdom, of our longest living elders, promote propagation of healthful lifestyles by following traditional ways and taking care of body, mind, spirit and our environment. Further field research among a larger cohort is required to fully generalize the findings of this study, but much of it is consistent with what we already know should be done. These data begin illustration of practice wisdom for implementation and serve to engage our universities, our hospitals, our industries, and our students, who we must position toward social change.

Ciprofloxacin-induced torsades de pointes in a methadone-dependent patient.

ABSTRACT Background Methadone has been associated with QT prolongation and Torsades de pointes. Ciprofloxacin may prolong QT interval and induce Torsades de pointes when other risk factors are present. Case description A case is described in which a patient receiving methadone treatment developed Torsades de pointes following the addition of ciprofloxacin. Conclusion Ciprofloxacin should be used with caution in patients receiving methadone.