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OBJECTIVE: The goals of this quality improvement project are to assess the BRIDGE Student-Run Free Clinic's adherence to the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease and to compare our rate of statin prescription to the national average and to uninsured groups. METHODS: A quality improvement project of 205 patients qualified by initial inclusion criteria at a student-run free healthcare clinic. Socio-demographic information, clinical measures associated with cardiovascular risk, and documentation regarding statin prescription at the follow-up visit after a patient's first lipid panel were abstracted from medical records. Descriptive statistics were calculated on the sample (proportions, means), and the proportion of patients eligible for statin treatment was determined. RESULTS: Of 58 patients eligible by guidelines to receive statins, 29 received a statin (50%) at their follow-up visit. Patients with clinical atherosclerotic cardiovascular disease (ASCVD) were more likely to receive statin therapy (83.3%) compared to other groups. Patients who were prescribed a statin were older, had higher total cholesterol, higher low-density lipoprotein (LDL), higher systolic blood pressure, and had higher ASCVD risk. Patients receiving statins were also more likely to be male or have a history of either hypertension, diabetes, or clinical ASCVD. CONCLUSION: Patients with established ASCVD had high rates of statin prescription. Following the first lipid panel, clinicians prescribed statins to approximately 50% of eligible patients. Although this proportion is below the national average for insured patients, it is higher than the national average for uninsured patients and represents a relatively high proportion of eligible patients within the examined time frame.
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Duchenne muscular dystrophy (DMD) is characterized by a progressive replacement of muscle by fat and fibrous tissue, muscle weakness, and loss of functional abilities. Impaired vasodilatory and blood flow responses to muscle activation have also been observed in DMD and associated with mislocalization of neuronal nitric oxide synthase mu (nNOSµ) from the sarcolemma. The objective of this study was to determine whether the postcontractile blood oxygen level-dependent (BOLD) MRI response is impaired in DMD and correlated with established markers of disease severity in DMD, including MRI muscle fat fraction (FF) and clinical functional measures. Young boys with DMD (n = 16, 5-14 yr) and unaffected controls (n = 16, 5-14 yr) were evaluated using postcontractile BOLD, FF, and functional assessments. The BOLD response was measured following five brief (2 s) maximal voluntary dorsiflexion contractions, each separated by 1 min of rest. FFs from the anterior compartment lower leg muscles were quantified via chemical shift-encoded imaging. Functional abilities were assessed using the 10 m walk/run and the 6-min walk distance (6MWD). The peak BOLD responses in the tibialis anterior and extensor digitorum longus were reduced (P < 0.001) in DMD compared with controls. Furthermore, the anterior compartment peak BOLD response correlated with function (6MWD ρ = 0.87, P < 0.0001; 10 m walk/run time ρ = -0.78, P < 0.001) and FF (ρ = -0.52, P = 0.05). The reduced postcontractile BOLD response in DMD may reflect impaired microvascular function. The relationship observed between the postcontractile peak BOLD response and functional measures and FF suggests that the BOLD response is altered with disease severity in DMD.NEW & NOTEWORTHY This study examined the postcontractile blood oxygen level-dependent (BOLD) response in boys with Duchenne muscular dystrophy (DMD) and unaffected controls, and correlated this measure to markers of disease severity. Our findings indicate that the postcontractile BOLD response is impaired in DMD after brief muscle contractions, is correlated to disease severity, and may be valuable to implement in future studies to evaluate treatments targeting microvascular function in DMD.