Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8. 7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants

AIMS Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. METHODS AND RESULTS After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64­0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68­1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69­0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69­0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8.7 years. CONCLUSION The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a legacy effect.

Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants.

AIMS: Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. METHODS AND RESULTS: After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8.7 years. CONCLUSION: The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a legacy effect. TRIAL REGISTRATION NUMBER: NCT00468923.

Comparison of Suicide Attempts/Behaviors Following Smoking Cessation Treatments Among Schizophrenic Smokers.

BACKGROUND: Smoking cessation may lead to depression in some smokers and result in increased risk of suicide. OBJECTIVE: To compare the risk of suicide attempts/behaviors associated with different smoking cessation medications among schizophrenic patients. METHODS: A retrospective cohort study was conducted using General Electric (GE) medical record database (1995-2011). The first day of being prescribed a smoking cessation medication defined as index date. Patients were followed up to one year from index date. Patients' suicide behaviors or attempts were identified through ICD-9 codes and E-codes. Cox proportional hazards model was applied to examine the association between smoking cessation medication and suicidal/self-injurious behaviors. RESULTS: Our cohort consisted of 3925 patients with diagnosis of schizophrenia or schizoaffective disorder who initiated cessation medication. Among them, 104 (2.65%) had suicide attempts or behavior within one-year follow up. However, statistically significant difference in the risk of suicide attempts/behaviors was not detected across cessation regimens in the Cox proportional hazard analysis. Only comorbidity index was found to be associated with suicide, which showed that higher Charlson comorbidity index was associated with higher risks of suicide behaviors within one year (HR=1.15, 95% CI=1.04-1.27). CONCLUSION: There were no significant differences in suicide attempts/behaviors with different cessation medications.

Comparative Effectiveness of Smoking Cessation Medications to Attenuate Weight Gain Following Cessation.

OBJECTIVE: To compare the postcessation weight gain following the use of different FDA-approved smoking cessation medications among obese smokers. METHODS: A retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006-2011). The cohort consisted of obese adult smokers newly initiating use of an FDA-approved smoking cessation medication (i.e., bupropion vs. varenicline). The outcome variable was weight change at 3, 6, or 12 months following the first prescription. Descriptive analyses and t-tests were conducted to assess the frequency distribution of sample characteristics and their association with the postcessation weight change. Multivariate linear regression models were carried out to compare the weight change among the FDA-approved smoking cessation medications and to identify predictors of weight change at 3, 6, and 12 months after assessing the model assumptions. RESULTS: The mean weight gain was 1.14 pounds (±17.26), 2.06 pounds (±18.46), and 3.06 pounds (±20.78) at 3-, 6-, and 12-month, respectively. Obese smokers who were prescribed varenicline had a mean weight gain of 1.18 pounds (±16.75), 2.14 pounds (±18.14), and 3.12 pounds (±20.89) for each follow up, while those who were prescribed bupropion had a mean weight gain of 0.23 pounds (±25.90), 0.22 pounds (±25.32), and 1.47 pounds (±17.50), respectively. Descriptive analysis showed that obese smokers taking bupropion had less weight gain than those taking varenicline at each follow up; however, this association was not statistically significant after accounting for all covariates. CONCLUSIONS: While patients using bupropion gained slightly less weight compared to those using varenicline, type of smoking cessation medication was not a significant predictor of weight change in the multivariate linear regression model.

Comparison of Diabetes Risk Following Smoking Cessation Treatment Using Varenicline Versus Bupropion Among Obese Smokers.

BACKGROUND: Recent literature suggests an initial increased risk of diabetes following smoking cessation. OBJECTIVES: To compare the risk of developing diabetes among obese smokers who tried to quit smoking using bupropion versus varenicline. METHODS: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006-2011). The cohort consisted of obese adult smokers without a diabetes diagnosis at baseline and newly initiating use of either bupropion or varenicline. This cohort was then followed for 1 year to observe the risk of developing diabetes. The relative risk of bupropion versus varenicline on developing diabetes was assessed using Cox Proportional Hazards regression model after controlling for covariates. RESULTS: The sample comprised of 78,002 obese smokers of which 1,937 (2.36%) developed diabetes during 1 year follow-up. Diabetes incidence rate was relatively comparable who used varenicline and bupropion (23.50 versus 25.80 per 1,000 person-years). Obese smokers who were prescribed bupropion had a statistically significant higher risk of developing diabetes during 1 year following cessation treatment than those who were prescribed varenicline. ([HR]: 1.58, 95% CI: 1.09-2.27) in the multivariate model. CONCLUSIONS/IMPORTANCE: Obese smokers who were prescribed bupropion might have a higher risk of developing diabetes during 1 year follow up compared to those who were prescribed varenicline. The clinical significance of the finding that bupropion had a higher risk of developing diabetes may need further investigation.

The social norms and beliefs of teenage male electronic cigarette use.

Electronic cigarettes (e-cigarettes) are novel, battery-operated inhalation devices that provide warm, vaporized nicotine, and often propylene glycol, to users without the inclusion of tobacco smoke. Because men, in general, are more likely to use cigarettes and illicit drugs than women, a qualitative study was undertaken to investigate the beliefs and perceived social norms regarding this issue among 47 teenage boys who self-identified themselves as current e-cigarette smokers. The majority of respondents reported that they used e-cigarettes because of expeditious consumption and concealment. Furthermore, the most common places respondents self-reported using e-cigarettes were everywhere, in school bathrooms, at home, and in school staircases. Interestingly, respondents stated that e-cigarettes are popular because they are accessible, healthier than tobacco cigarettes, and more aesthetically pleasing. Because of the growing popularity and uncertainty regarding the social and physical consequences of e-cigarettes, this study shows a need for additional research discovery.

Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk.

A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.

Waterpipe smoking among students in one US university: predictors of an intention to quit.

OBJECTIVE: To examine the intention to quit waterpipe smoking among college students. PARTICIPANTS: A total of 276 University of Houston students identified through an online survey administered in February 2011. Participants indicated they had smoked a waterpipe in the month prior to the survey. METHODS: Cross-sectional study. Questions included demographics, tobacco use, perceived risk of waterpipe smoking, and social acceptability. Multivariate logistic regression was used to determine predictors of an intention to quit. RESULTS: Most of the sample participants (n = 227; 83%) reported that they had no intention to quit. Students believing that waterpipe smoking was harmful were more likely to have an intention to quit (odd ratio [OR] = 2.38, 95% confidence interval [CI; 1.05, 5.36]). Those who smoked for more than 60 minutes were less likely to have a desire to quit (OR = 0.29, 95% CI [0.12, 0.73]). CONCLUSIONS: The low level of a desire to quit demonstrated underscores the urgent need to develop interventions that educate users about expected harms of continued use.

Cigarette smoking among Jordanian adults.

The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Beliefs and perceived norms concerning smoking cessation program recruitment among African American teen smokers: what appeals to youth and what turns them away.

A qualitative approach was used to investigate the beliefs and perceived norms about participation in smoking cessation programs among a sample of African American alternative school students (N = 53), aged 14 to 18 years old, in the United States who were current smokers. The authors found that the majority of participants felt that smoking cessation programs were not effective, caused smoking, or lacked activities. Both boys and girls believed that communication sources that provided direct messages in real situations were the best motivators or incentives for African American youth recruitment into smoking cessation programs. These findings support research that African Americans are more attentive to communications that involve direct personal stimuli. In addition, African Americans place heavy emphasis on source and message style to determine credibility of the intervention strategy.

The association of drug use and post-traumatic stress reactions due to Hurricane Ike among Fifth Ward Houstonian youth.

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last week they tried to keep from thinking or talking about the hurricane or things that remind them of what happen were significantly more likely to use alcohol (p < .05), marijuana (p < .01), codeine cough syrup (p < .00), anti-energy drinks (p < .00), crystal methamphetamines (p < .00), and Viagra (p < .00). Unadjusted logistic regression showed that they also experienced over twice the odds of reporting past 30 day use of alcohol (OR = 2.57, 95% CI = .98, 6.8), marijuana (OR = 4.31, 95% CI = 1.2, 15.3), codeine cough syrup (OR = 5.22, 95% CI = 1.4, 19.5), and anti-energy drinks (OR = 3.27, 95% CI = 1.0, 1.4). Adjusted logistic regression revealed that male youth post-traumatic stress reaction is a significant predictor of marijuana use (OR = 4.1, 95% CI = 1.0, 16.5). This study shows the important link of higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters.

Correlates of HIV knowledge and sexual risk behaviors among female military personnel.

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.

Smoking cessation recruitment among African American youth: what youth think will help them attend.

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio 95% confidence interval CI=1.96; 12.40), health educators (4.70 AOR; 95% CI=1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI=1.04; 9.80), teachers (2.73 AOR; 95% CI=1.3; 5.60), and celebrities (2.44 AOR; 95% CI=1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI=1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI=1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth.

The link between recent sexual abuse and drug use among African American male college students: it's not just a female problem in and around campus.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p < or = 0.001) and past 30 day (OR = 5.0, p < or = 0.001) drug use.

Substance use problems reported by historically Black college students: combined marijuana and alcohol use versus alcohol alone.

Using secondary data analysis,this study compares alcohol and other drug (AOD) problems experienced by African-American students attending a historically Black university who use alcohol only versus those who use alcohol plus marijuana. Results indicate that students who used marijuana plus alcohol experienced more AOD problems than their counterparts who used alcohol only. The current findings are similar to previous research with a majority White college student population.

The use of fry (embalming fluid and PCP-laced cigarettes or marijuana sticks) among crack cocaine smokers.

Statistics show that the prevalence of crack cocaine use and embalming fluid and phencyclidine (PCP)-laced cigarettes or marijuana sticks, commonly referred to on the street as "fry" or "wet" is a problem; however, the relationship between these substances of abuse and concurrent polydrug use is unknown. In the present study, a cross-sectional survey was conducted among 426 African-American crack users in Houston, Texas, to investigate the difference between those who concurrently reported lifetime (defined as at least one usage of fry in life) fry use and those who stated they never used fry. The data were analyzed using chi-square and logistic regression analyses. Fry users were significantly more likely than non-users to not have a casual sex partner (92% users vs. 84% non-users, p < or = 0.05) and were more likely to have been diagnosed with gonorrhea in the past 12 months (9% users vs. 2% non-users, p < or = 0.05). In addition fry users had significantly higher odds of currently trading sex for drugs (OR = 2.30, p < or = 0.05), marijuana use (OR = 12.11, p < or = 0.05), and codeine (syrup) use (OR = 8.10, p < or = 0.05). These findings are important in determining the "cultural novelties" relative to crack and fry use among younger African Americans.

An exploration of recent club drug use among rave attendees.

Raves are characterized by large numbers of youth dancing for long periods of time and by the use of "club drugs," such as 3, 4-methylenedioxymethamphetamine (MDMA or "ecstasy"). While a small body of research has explored the use of ecstasy and other club drugs (EOCD) among club rave attendees in the United States, we are aware of no studies that have investigated the relationship between EOCD use and high-risk sexual behaviors among members of this population. We explored the association between EOCD use and high-risk sexual behaviors among a sample of 283 club rave attendees interviewed during the spring and summer of 2005. Data were collected at 13 rave events in two different clubs along the Baltimore-Washington corridor between March 17 and September 3, 2005. Potential respondents were conveniently sampled and approached between 12 a.m. and 5 a.m. as they exited the clubs. Only 12% reported using ecstasy within the two days preceding the interview, findings considerably lower than our earlier studies of club rave attendees. Moreover, no significant relationship was discerned between recent MDMA use and high-risk sexual behavior. These findings suggest that the use of EOCD among rave attendees has diminished and that the allocation of significant resources to combat their proliferation, among this and other populations at risk for EOCD use, may be premature.