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2.
J Am Heart Assoc ; 10(6): e018835, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33653083

RESUMO

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity-specific CVD mortality and county-level factors. Methods and Results Using 2017 county-level data, we studied the association between race/ethnicity-specific CVD age-adjusted mortality rate (AAMR) and county-level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non-Hispanic White individuals in 2698 counties; 100 475 deaths among non-Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non-Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation (R2) in CVD AAMR was explained by physical inactivity for non-Hispanic White individuals (32.3%), median household income for non-Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county-level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non-Hispanic White individuals (35.3%), socioeconomic factors for non-Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity-specific age-adjusted CVD mortality and county-level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

3.
Cardiol Ther ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33620669

RESUMO

Cardiac injury is infrequently described as a complication of snake bite envenomation. We present the case of a 62-year-old male with shortness of breath, right lower extremity edema, and elevated cardiac troponin 6 days after a Northern Pacific rattlesnake bite.

4.
Obes Surg ; 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33598844

RESUMO

INTRODUCTION: Metabolic surgery for managing class 1 obesity and type 2 diabetes mellitus has recently gained popularity. The Latino population presents high rates of these diseases. Reports on surgical outcomes in this population are scarce. METHODS: Prospective study with Mexican patients diagnosed with diabetes and class 1 obesity submitted to Roux-en-Y gastric bypass. The objective was to determine short-, mid-, and long-term outcomes (weight loss, metabolic, morbidity, and diabetes remission). Sub-analysis was included, based on preoperative usage of one (group A) or more (group B) oral hypoglycemic agents ± insulin. RESULTS: Fifty-one patients with a mean body mass index of 33.1 ± 1.9 kg/m2, and glycated hemoglobin 7.2 ± 1.7% were included. Significant improvements were observed in almost every parameter. At 24, 36, and 60 months, complete diabetes remission was achieved in 73.8%, 52.2%, and 50% of patients with glycated hemoglobin levels of 5.7% ± 0.8%, 5.8% ± 0.5%, and 6.1% ± 0.8%, respectively. At 24, 36, and 60 months, patients in group A (N=28) showed 90.9%, 69.2%, and 75% remission, respectively, versus patients in group B (N=23), who had remission rates of 50%, 30%, and 25% during the same period. Diabetes relapse was higher in patients using ≥ 2 oral hypoglycemic agents ± insulin before surgery. CONCLUSION: Gastric bypass is a safe and effective metabolic surgery that results in excellent mid- and long-term results among Mexicans. Patients using one drug preoperatively showed improved results and remission rates, which underscores the importance of intervening in the early stages of the disease. TRIAL REGISTRATION: Clinical Trials identifier: NCT04595396 ( www.ClinicalTrials.gov ).

5.
Artigo em Inglês | MEDLINE | ID: mdl-33557415

RESUMO

Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

8.
J Am Geriatr Soc ; 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33410499

RESUMO

BACKGROUND/OBJECTIVES: Older adults (>75 years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD. DESIGN: Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018. SETTING: A large multi-specialty health system in Northern California. PARTICIPANTS: A total of 24,651 adults older than 75 years with ASCVD. MEASUREMENTS: Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors. RESULTS: The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins. CONCLUSIONS: Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.

9.
Nat Genet ; 53(2): 185-194, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33462484

RESUMO

Clinical laboratory tests are a critical component of the continuum of care. We evaluate the genetic basis of 35 blood and urine laboratory measurements in the UK Biobank (n = 363,228 individuals). We identify 1,857 loci associated with at least one trait, containing 3,374 fine-mapped associations and additional sets of large-effect (>0.1 s.d.) protein-altering, human leukocyte antigen (HLA) and copy number variant (CNV) associations. Through Mendelian randomization (MR) analysis, we discover 51 causal relationships, including previously known agonistic effects of urate on gout and cystatin C on stroke. Finally, we develop polygenic risk scores (PRSs) for each biomarker and build 'multi-PRS' models for diseases using 35 PRSs simultaneously, which improved chronic kidney disease, type 2 diabetes, gout and alcoholic cirrhosis genetic risk stratification in an independent dataset (FinnGen; n = 135,500) relative to single-disease PRSs. Together, our results delineate the genetic basis of biomarkers and their causal influences on diseases and improve genetic risk stratification for common diseases.


Assuntos
Biomarcadores/sangue , Biomarcadores/urina , Antígenos HLA/genética , Proteínas/genética , Bancos de Espécimes Biológicos , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/metabolismo , Variações do Número de Cópias de DNA , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Pleiotropia Genética , Humanos , Desequilíbrio de Ligação , Transportador 1 de Ânion Orgânico Específico do Fígado/genética , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Insuficiência Renal Crônica , Serina Endopeptidases/genética , Reino Unido
11.
Artigo em Inglês | MEDLINE | ID: mdl-33229378

RESUMO

INTRODUCTION: Population-level and individual-level analyses have strengths and limitations as do 'blackbox' machine learning (ML) and traditional, interpretable models. Diabetes mellitus (DM) is a leading cause of morbidity and mortality with complex sociodemographic dynamics that have not been analyzed in a way that leverages population-level and individual-level data as well as traditional epidemiological and ML models. We analyzed complementary individual-level and county-level datasets with both regression and ML methods to study the association between sociodemographic factors and DM. RESEARCH DESIGN AND METHODS: County-level DM prevalence, demographics, and socioeconomic status (SES) factors were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings and merged with US Census data. Analogous individual-level data were extracted from 2007 to 2016 National Health and Nutrition Examination Survey studies and corrected for oversampling with survey weights. We used multivariate linear (logistic) regression and ML regression (classification) models for county (individual) data. Regression and ML models were compared using measures of explained variation (area under the receiver operating characteristic curve (AUC) and R2). RESULTS: Among the 3138 counties assessed, the mean DM prevalence was 11.4% (range: 3.0%-21.1%). Among the 12 824 individuals assessed, 1688 met DM criteria (13.2% unweighted; 10.2% weighted). Age, gender, race/ethnicity, income, and education were associated with DM at the county and individual levels. Higher county Hispanic ethnic density was negatively associated with county DM prevalence, while Hispanic ethnicity was positively associated with individual DM. ML outperformed regression in both datasets (mean R2 of 0.679 vs 0.610, respectively (p<0.001) for county-level data; mean AUC of 0.737 vs 0.727 (p<0.0427) for individual-level data). CONCLUSIONS: Hispanic individuals are at higher risk of DM, while counties with larger Hispanic populations have lower DM prevalence. Analyses of population-level and individual-level data with multiple methods may afford more confidence in results and identify areas for further study.

12.
Circulation ; 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200953

RESUMO

Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

13.
Circulation ; : CIR0000000000000936, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170755

RESUMO

Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

14.
Artigo em Inglês | MEDLINE | ID: mdl-33223802

RESUMO

Purpose of review: Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds. Recent findings: Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions. Summary: Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.

15.
Artigo em Inglês | MEDLINE | ID: mdl-33205274

RESUMO

Bioaerosols are emitted during the biological treatment of water, soil, and air pollutants. The elimination of these pollutants has become a priority due to their detrimental effects on human health. Advanced oxidation technologies have been used to control bioaerosol emissions specially to improve indoor air quality. This investigation was focused on evaluating the biofiltration of ethyl acetate vapors in terms of removal efficiency and bioaerosol emission. Also, a continuous photocatalytic process to inactivate bioaerosols emitted from the biofilter was assessed as a post-treatment. The photocatalysis was developed with ZnO and TiO2 immobilized onto Poraver glass beads. Flow cytometry (FC) coupled with fluorochromes was used to characterize and quantify bioaerosol emissions in terms of live, dead, and injured cells. Ethyl acetate removal efficiencies were maintained in a steady state with values of 100% under 60-g m-3 h-1 inlet load (IL). Biomass concentration in the biofilter reached values up to 228 mgbiomass gperlite-1 at day 56 of operation, but the spontaneous occurrence of predatory mites diminished biomass concentration by 33%. Bioaerosols emitted during the steady-state operation of the biofilter were composed mainly by bacteria (~ 94%) and in a less extent of fungal spores (0.29-6%). The most efficient photocatalytic system comprised TiO2/Poraver with 78% inactivation of bioaerosols during the first 2 h of the process, whereas the ZnO/Poraver system showed null activity (~ 0%) of inactivation. FC results show that the main mechanism of inactivation of TiO2/Poraver was cell death.

16.
NPJ Digit Med ; 3: 125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33043149

RESUMO

The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

17.
Rev. salud pública Parag ; 10(2): [P30-P36], octubre 2020.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1146900

RESUMO

Introducción: Staphylococcus aureus es considerado uno de los patógenos humanos más importantes a nivel mundial y sus niveles de resistencia a meticilina han aumentado incluso en cepas aisladas de personas sin factores de riesgo nosocomial, por lo que la tipificación genética de los clones circulantes es fundamental para comprender los patrones de diseminación. Objetivo: Obtener la tipificación de SARM que causaron infecciones invasivas a niños mediante el empleo de la técnica de análisis multi-locus de número variable de repeticiones en tándem (MLVA) automatizada. Materiales y Métodos: Estudio observacional, descriptivo de corte transverso. Resultados: Se analizaron 25 cepas SARM que representan más de 700 aislamientos de S. aureus colectados en los años 2010, 2012 y 2013 de 4 hospitales de referencia nacional. La automatización de la técnica MLVA incluyó la tipificación del 88% (22/25) de los aislamientos en estudio, resultando 3 perfiles diferentes, cada uno asociado a un "spa tipo" distinto, siendo el perfil 1-t019 el predominante (86%), seguido por el perfil 3-t002 (9%), arrojando 100% de concordancia con el método MLVA manual, así como una alta concordancia con el método estándar de oro, PFGE. Conclusiones: La inclusión de un método de análisis de fragmentos automatizado permitió llevar a cabo la caracterización de aislamientos mejorando el tiempo de respuesta y manteniendo una alta sensibilidad en comparación con el método manual.


Introduction: Staphylococcus aureusis considered one of the most critical human pathogens worldwide, and its levels of methicillin resistance have increased even in strains isolated from people without nosocomial risk factors. Therefore the genetic typing of circulating clones is essential to understand dissemination patterns. Objective: Obtain the MRSA typing that caused invasive infections in children by using the automated multi-locus variable number of tandem repeats (MLVA) analysis technique. Materials and methods: Observational, descriptive, cross-sectional. Results: 25 strains MRSA representing more than 700S. aureusisolates collected in 2010, 2012, and 2013 from 4 national reference hospitals were analyzed. The MLVA automation included the typing of 88% (22/25) isolates, resulting in 3 different profiles, each one associated with a different spa type, being the 1-t019 the predominant (86%), followed by the 3-t002 profile (9%), yielding 100% concordance with the MLVA manual, as well as high concordance with the standard gold method, PFGE. Conclusions: The inclusion of an automated fragment analysis method led to the characterization of isolates, improving response time, and maintaining high sensitivity compared to the manual process.

18.
Cardiovasc Diagn Ther ; 10(4): 1048-1067, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32968660

RESUMO

Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.

20.
Eur J Hum Genet ; 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873964

RESUMO

Sex differences have been shown in laboratory biomarkers; however, the extent to which this is due to genetics is unknown. In this study, we infer sex-specific genetic parameters (heritability and genetic correlation) across 33 quantitative biomarker traits in 181,064 females and 156,135 males from the UK Biobank study. We apply a Bayesian Mixture Model, Sex Effects Mixture Model (SEMM), to Genome-wide Association Study summary statistics in order to (1) estimate the contributions of sex to the genetic variance of these biomarkers and (2) identify variants whose statistical association with these traits is sex-specific. We find that the genetics of most biomarker traits are shared between males and females, with the notable exception of testosterone, where we identify 119 female and 445 male-specific variants. These include protein-altering variants in steroid hormone production genes (POR, UGT2B7). Using the sex-specific variants as genetic instruments for Mendelian randomization, we find evidence for causal links between testosterone levels and height, body mass index, waist and hip circumference, and type 2 diabetes. We also show that sex-specific polygenic risk score models for testosterone outperform a combined model. Overall, these results demonstrate that while sex has a limited role in the genetics of most biomarker traits, sex plays an important role in testosterone genetics.

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