BAG3: Nature's Quintessential Multi-Functional Protein Functions as a Ubiquitous Intra-Cellular Glue.

BAG3 is a 575 amino acid protein that is found throughout the animal kingdom and homologs have been identified in plants. The protein is expressed ubiquitously but is most prominent in cardiac muscle, skeletal muscle, the brain and in many cancers. We describe BAG3 as a quintessential multi-functional protein. It supports autophagy of both misfolded proteins and damaged organelles, inhibits apoptosis, maintains the homeostasis of the mitochondria, and facilitates excitation contraction coupling through the L-type calcium channel and the beta-adrenergic receptor. High levels of BAG3 are associated with insensitivity to chemotherapy in malignant cells whereas both loss of function and gain of function variants are associated with cardiomyopathy.

Outpatient clinic attendance and outcomes among patients hospitalized with diabetic foot ulcers.

BACKGROUND: There are limited data on post-hospital discharge clinic attendance rates and outcomes among patients with diabetic foot ulcers (DFUs). METHODS: Retrospective study of patients hospitalized with a DFU from 2016 to 2019 in a large public hospital. We measured rates and predictors of clinic attendance with providers involved with DFU care within 30 days of hospital discharge ("30-day post-discharge clinic attendance"). Log-binomial regression was used to estimate risk ratios (RR) and 95 % confidence intervals (CI). RESULTS: Among 888 patients, 60.0 % were between 45 and 64 years old, 80.5 % were Black, and 24.1 % were uninsured. Overall, 478 (53.8 %) attended ≥1 30-day post-discharge clinic appointment. Initial hospital outcomes were associated with clinic attendance. For example, the RR of 30-day post-discharge clinic attendance was 1.39 (95%CI 1.19-1.61) among patients who underwent a major amputation compared to patients with DFUs without osteomyelitis and did not undergo an amputation during the initial hospitalization. Among 390 patients with known 12-month outcome, 71 (18.2 %) had a major amputation or died ≤12 months of hospital discharge. CONCLUSION: We found a low post-discharge clinic attendance and high post-discharge amputation and death rates among patients hospitalized with DFUs. Interventions to increase access to outpatient DFU care are needed and could prevent amputations.

Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease.

Background Educational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied. Methods and Results Patients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all-cause mortality and secondary outcomes were a composite of cardiovascular death/non-fatal myocardial infarction and non-fatal myocardial infarction during follow-up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow-up, there were 1066 all-cause deaths, 812 cardiovascular deaths/non-fatal myocardial infarction, and 276 non-fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality (hazard ratios 1.52 [95% CI 1.11-2.09]; 1.43 [95% CI 1.17-1.73]; and 95% CI 1.26 [1.03-1.53], respectively). Similar findings were observed for secondary outcomes. Conclusions Low educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high-risk patient population need further investigation.

Sleep Duration and Mortality in Patients With Coronary Artery Disease.

Extremes in sleep duration are associated with higher cardiovascular risk in the general population, but their impact in patients with documented coronary artery disease (CAD) remains unknown and potentially of clinical significance. We hypothesized that both short and long sleep duration are associated with higher mortality in CAD. We inquired about sleep durations in 2,846 patients enrolled in the Emory Cardiovascular Biobank (mean age 64 years, 38% female, 23% Black, and 82% with obstructive CAD, defined by positive coronary angiography), who were then followed for all-cause and cardiovascular mortality. Multivariate Cox proportional hazard models were calculated to examine the association of sleep duration and mortality. Sleep durations of <6.5 hours (short), ≥6.5 to <7.5 hours (normal), and ≥7.5 hours (long) were reported by 39%, 26% and 35% of the cohort, respectively. On follow-up (median 2.8 years), mortality rates were 15%, 11%, and 17%, respectively. After adjusting for demographics and risk factors, both short and long sleep duration were associated with higher all-cause mortality (hazard ratio 1.44, 95% confidence interval [1.10 to 1.89], and 1.41 [1.08 to 1.85], respectively). A similar pattern was demonstrated for cardiovascular mortality only for short (hazard ratio 1.48 [1.05 to 2.09]), but not long sleep duration. In conclusion, in patients with frank CAD, both short and long sleep duration were independently associated with higher all-cause mortality, and short sleep was independently associated with higher cardiovascular mortality. In conclusion, our study is the first to extend the observations of sleep duration and mortality from population-based studies to patients with documented cardiac disease.