Social determinants of health and its impact on cardiovascular disease in underserved populations: A critical review.

In the United States, a patient succumbs to cardiovascular disease (CVD) every 33 seconds and costs the healthcare system close to $240 billion dollars annually. Social determinants of health (SDOH) are key factors responsible in structuring the well-being of individuals and communities. It significantly influences health outcomes and is reliant on several factors such as economic stability, education, healthcare access, community composition, and governmental policies. This review explores the impact of SDOH on the escalating global burden of CVD and identifies potential modifiable risk factors that contribute to acute coronary syndrome (ACS) among underserved communities. In addition, it also addresses the necessity for interventions to narrow healthcare related disparities ensuring improvement in CVD outcomes in this subgroup of population.

Marijuana-induced ST-elevation myocardial infarction in adolescents and young adults: A case report and comprehensive review of literature.

As per the Centers for Disease Control and Prevention (CDC), the incidence of myocardial infarction (MI) is reported to be 805,000 cases annually in the United States (US). Although commonly occurring in elderly individuals with underlying cardiovascular comorbidities or younger generations with familial predispositions serving as risk factors, it is extremely rare for an isolated event to occur in teenagers with a history of marijuana use. In this article, we report a rare case of ST-elevation myocardial infarction (STEMI) in a 19-year-old male with no past medical history that was attributed to marijuana use. This case report and review of literature depict a potential association between marijuana use and STEMI. We also highlight potential clinical implications to aid healthcare professionals in making an early diagnosis and achieving a timely management strategy.

Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure.

Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (≥3 of 4 following criteria: age ≥70 years, female gender, height ≤64 inches, and hypertension) referred to TRA operators were randomized to either right (n = 50) or left (n = 50) TRA, whereas those referred to transfemoral approach (TFA) operators were enrolled in a prospective registry (n = 50). The primary end point was the radiation measure of dose-area product (DAP). In an intention-to-treat analysis, DAP (34.1 Gy·cm(2) [24.9 to 45.6] vs 41.9 Gy·cm(2) [27.3 to 58.0], p = 0.08), fluoroscopy time (3.7 minutes [2.4 to 6.3] vs 5.6 minutes [3.1 to 8.7], p = 0.07), and operator radiation exposure (516 µR [275 to 967] vs 730 µR [503 to 1,165], p = 0.06) were not significantly different between left and right TRA, but total dose (411 mGy [310 to 592] vs 537 mGy [368 to 780], p = 0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5 Gy·cm(2) [15.7 to 33.2], p <0.001; fluoroscopy time 2.3 minutes [1.5 to 3.7], p <0.001; operator radiation exposure 387 µR [264 to 557]; total dose 345 mGy [250 to 468], p = 0.001). Results were similar after adjustment for differences in baseline characteristics. In conclusion, median measurements of radiation were overall not significantly different between left versus right TRA in this select population of patients with predictors of TRA failure. All measurements of radiation were lowest in the TFA group.