Residing in a Food Desert and Adverse Cardiovascular Events in US Veterans With Established Cardiovascular Disease.

Residents living in a "food desert" are known to be at a higher risk for developing cardiovascular disease (CVD). However, national-level data regarding the influence of residing in a food desert in patients with established CVD is lacking. Data from veterans with established atherosclerotic CVD who received outpatient care in the Veterans Health Administration system between January 2016 and December 2021 were obtained, with follow-up information collected until May 2022 (median follow-up: 4.3 years). A food desert was defined using the United States Department of Agriculture criteria, and census tract data were used to identify Veterans in these areas. All-cause mortality and the occurrence of major adverse cardiovascular events (MACEs; a composite of myocardial infarction/stroke/heart failure/all-cause mortality) were evaluated as the co-primary end points. The relative risk for MACE in food desert areas was evaluated by fitting multivariable Cox models adjusted for age, gender, race, ethnicity, and median household income, with food desert status as the primary exposure. Of the 1,640,346 patients (mean age 72 years, women 2.7%, White 77.7%, Hispanic 3.4%), 25,7814 (15.7%) belonged to the food desert group. Patients residing in food deserts were younger; more likely to be Black (22% vs 13%)or Hispanic (4% vs 3.5%); and had a higher prevalence of diabetes mellitus (52.7% vs 49.8%), chronic kidney disease (31.8% vs 30.4%,) and heart failure (25.6% vs 23.8%). Adjusted for covariates, food desert patients had a higher risk of MACE (hazard ratio 1.040 [1.033 to 1.047]; p <0.001) and all-cause mortality (hazard ratio 1.032 [1.024 to 1.039]; p <0.001). In conclusion, we observed that a large proportion of US veterans with established atherosclerotic CVD reside in food desert census tracts. Adjusting for age, gender, race, and ethnicity, residing in food deserts was associated with a higher risk of adverse cardiac events and all-cause mortality.

Systematic review and meta-analysis: a brief introduction.

LEARNING OBJECTIVES: 1. Understand the basic structure and parts of a systematic review 2. Be able to read and critically appraise a published systematic review.

Model-free estimates that complement information obtained from the hazard ratio.

Understand the limitations of the modeling of survival data, especially as pertains to the Cox proportional hazards model.An introduction to model-free estimates of survival, namely, the restricted mean survival time/restricted mean lost time.Use R (The R Foundation for Statistical Computing, Austria) or STATA® (The STATACorp, College Station, TX, USA) to perform analyses and obtain these parameters from a dataset. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-021-01167-4.

Survival analysis-part 3: intermediate events and the importance of competing risks.

LEARNING OBJECTIVES: Understand what events can be labelled as intermediate events in survival analysis.Understand why the Kaplan and Meier method cannot be used in the presence of competing events.Regression analysis in the presence of competing events.

Survival analysis-part 2: Cox proportional hazards model.

Learning objectives: 1. To understand the log-rank test and limitations of the log-rank test in comparing survival between groups. 2. To understand the fundamental concepts of the proportional hazards assumption. 3. To understand basic steps in the development of the Cox proportional hazards model and reported hazard ratios. 4. To understand how results of a Cox model run using STATA© (a commonly used proprietary statistical software) can be understood and interpreted. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-020-01108-7.

Current role of saphenous vein graft in coronary artery bypass grafting.

Saphenous vein was the conduit used in the first series of coronary artery bypass grafting (CABG), and, with the exception of surgical revascularization of the left anterior descending artery, it remains the most commonly used bypass conduit. However, its durability and longevity are not ideal. Arterial grafts have better patency than saphenous vein grafts and therefore should be preferred over them. However, in certain situations, like grafting right coronary arteries with lesser degree of proximal stenosis and higher competitive flow, or in certain patient populations, like those at very high risk of wound infections and octogenarians, arterial grafting may not be the best option and saphenous vein grafting should be considered instead.