The effect of donor-recipient sex matches on lung transplant survival: An analysis of the United Network for Organ Sharing database.

Objective: To investigate the impact of donor-recipient (DR) sex matches on survival after lung transplantation while controlling for size difference in the United Network of Organ Sharing (UNOS) database. Methods: We performed a retrospective study of 27,423 lung transplant recipients who were reported in the UNOS database (January 2005-March 2020). Patients were divided into groups based on their respective DR sex match: male to male (MM), male to female (MF), female to female, (FF), and female to male (FM). Kaplan-Meier curve and Cox regression with log-rank tests were used to assess 1-, 3-, 5-, and 10-year survival. We also modeled survival for each group after controlling for size-related variables via the Cox regression. Results: Kaplan-Meier curves showed overall significance at 1-, 3-, 5-, and 10-year end points (P < .0001). Estimated median survival time based on Kaplan-Meier analysis were 6.41 ± 0.15, 6.13 ± 0.18, 5.86 ± 0.10, and 5.37 ± 0.17 years for FF, MF, MM, and FM, respectively (P < .0001). After we controlled for size differences, FF had statistically significantly longer 5- and 10-year survival than all other cohorts. MF also had statistically significantly longer 5- and 10-year survival than FM. Conclusions: When variables associated with size were controlled for, FF had improved survival than other DR groups. A female recipient may experience longer survival with a female donor's lungs versus a male donor's lungs of similar size.

Community-based intervention for managing hypertension and diabetes in rural Bangladesh.

BACKGROUND: Approximately 80% of non-communicable diseases (NCDs) have been reported in low- and middle-income countries (LMICs). However, studies on the usefulness of educational interventions run by non-healthcare workers in combating NCDs in resource-limited areas in rural parts of LMICs are limited. This study aimed to identify the effectiveness of a community-based simple educational program run by non-healthcare trained staff for several outcomes associated with NCDs in a resource-limited area. METHODS: Six villages in the Narail district in Bangladesh were selected, two each in the first and second intervention and the control groups, in the Narail district in Bangladesh were selected. Pre- and post-intervention survey data were collected. The first intervention group received the "strong" educational intervention that included a checklist poster on the wall, phone call messages, personalized advice papers, seminar videos, and face-to-face seminars. The second intervention group received a "weak" intervention that included only a checklist poster on the wall in their house. The outcome was the proportion of NCDs and changes in systolic blood pressure and blood sugar level. Confidential fixed-effects logistic regression and multiple linear regression were performed to identify the effectiveness of the intervention. RESULTS: Overall, 600 participants completed the baseline survey and the follow-up survey. The mean systolic blood pressure reduced by 7.3 mm Hg (95% confidence interval [CI] 4.6-9.9) in the first intervention group, 1.9 mm Hg (95% CI - 0.5-4.2) in the second intervention group, and 4.7 mm Hg (95% CI 2.4-7.0) in the control group. Multiple linear regression analysis showed that the between-group differences in the decline in systolic blood pressure were significant for the first intervention versus control (p = 0.001), but not for the second intervention versus control (p = 0.21). The between-group differences in the reduction in blood glucose after the intervention, were not significant on multiple linear regression analysis. CONCLUSIONS: Community-based educational interventions for NCDs provided by non-healthcare staff improved the outcomes of hypertension and risk behaviors. Well-designed community-based educational interventions should be frequently implemented to reduce NCDs in rural areas of low- and middle-income countries. Trial registration UMIN Clinical Trials Registry (UMIN-CTR; UMIN000050171) retrospectively registered on January 29, 2023.

Increased Risk Donors Utilized in Lung Transplantation At A Single Center.

Introduction: In 2013, the US Public Health Service (PHS) updated guidelines for high-risk donor organs and renamed the category increased risk. Project Aims: We compared survival of patients who received increased risk or non-increased risk donor lungs to determine if PHS designated increased risk donor lungs were an underutilized resource. Design: This retrospective cohort analysis compared survival and utilization rates of increased-risk and non-increased-risk donor lungs used in lung transplantation at a single institution over a period of 8 years (Feb-2012 through Mar-2020). Survival was assessed using Kaplan-Meier analysis and compared by log-rank test. Cox proportional hazards modeling was used to analyze impact on survival of variables significantly associated with risk status, including recipient ethnicity, lung allocation score (LAS), donor age, year of transplant procedure, and lung transplant type. Results: Of 744 lung transplant recipients from February 2012 through March 2020, there were 192 (26%) recipients of increased risk designated lungs. In 2012 and 2013, 6% and 0% respectively of the lungs transplanted were increased risk labeled. After the PHS guidelines were nationally implemented in February 2014, the proportion of increased risk lung transplants rose to 7% (2014), 21% (2015), 27% (2016), 35% (2017), 28% (2018), 27% (2019), and 40% (January-March 2020). Kaplan-Meier analysis and log-rank test comparison showed no significant difference in survival between patients that received increased risk versus non-increased risk labeled lungs (P = 0.47). Conclusions: Our analysis suggested the 2013 PHS increased risk designation threatened underutilization of viable donor lungs, providing further support for the 2020 PHS changes.

Anastomotic Suturing Techniques and Their Association With Post-Lung Transplantation Complications.

INTRODUCTION: Currently, standard practice is to use the continuous suturing technique on the bronchial anastomosis during lung transplantation. This study used a large cohort to investigate and contrast continuous and interrupted suturing techniques, comparing survival outcomes and occurrence of postoperative bronchial complications to examine if utilization of interrupted suturing has merit. METHODS: Survival outcomes of 740 single-center lung transplant recipients over 8 y (February 2012-March 2020) were compared by suturing techniques: either continuous or interrupted at the bronchial anastomosis. Clinical parameters and demographics were compared between two suturing groups, with P values < 0.05 considered significant. The groups were compared for postoperative morbidity, including need for bronchial interventions. Survival was compared using Kaplan-Meier curves and log-rank tests. Cox regression analysis was run with statistically significant variables to study association with survival. RESULTS: Of the 740 patients, 462 received the continuous suturing technique and 278 received the interrupted suturing technique. Most demographic and clinical data were not statistically significant between the two groups, and those that were significant were not associated with worse survival outcomes, with the exception of the variable diagnosis. Bronchial complications were comparable between the continuous and interrupted groups (12.6% versus 10.4%, P = 0.382). Extracorporeal membrane oxygenation (ECMO) use did not differ significantly between the two groups (P = 0.12). The Kaplan-Meier curve showed comparable survival between groups (P = 0.98), and Cox regression analysis showed that only diagnosis, bronchial complications, and ECMO utilization were associated with different survival outcomes. Chronic obstructive pulmonary disorder was shown to be associated with more favorable survival outcomes as opposed to idiopathic pulmonary fibrosis and the category "other". The need for ECMO and the occurrence of a bronchial complication were also associated with worse survival outcomes. CONCLUSIONS: Both techniques showed reasonable post-transplant outcomes, as our study demonstrated similar survival outcomes and bronchial complication rates.

Postoperative Bronchial Complications After Lung Transplantation Related to Anastomosis Suture.

BACKGROUND: Postoperative bronchial anastomotic complications are not uncommon in lung transplant recipients. We investigated 2 surgical techniques (continuous and interrupted sutures) during bronchial anastomosis, comparing survival and postoperative bronchial complications. METHODS: We retrospectively analyzed 421 patients who were transplanted in our center (February 2012 to March 2018). Patients were divided according to bronchial anastomotic technique (continuous or interrupted). Demographics and clinical parameters were compared for significance (P < .05). Comparison of postoperative morbidity included bronchial complications, venovenous extracorporeal membrane oxygenation support, and intervention requirements. Survival was assessed using Kaplan-Meier curve and log-rank tests (P < .05). RESULTS: Of the 421 patients, 290 underwent bronchial anastomoses with continuous suture; 44 of these patients had postoperative bronchial complications (15.2%). Contrarily, 131 patients underwent the interrupted suture technique; 9 patients in this group had postoperative bronchial complications (6.9%). Demographics and clinical parameters included age, sex, ethnicity, etiology, lung allocation score, body mass index, donor age, lung transplant type, cardiopulmonary bypass usage, surgical approaches, and median length of stay. Postoperative complications (continuous vs interrupted) were bronchial complications (P = .017), venovenous extracorporeal membrane oxygenation support (P = .41), venoarterial extracorporeal membrane oxygenation support (P = .38), and complications requiring dilatation with stent placement (P = .09). Kaplan-Meier curve showed better survival in the interrupted group (P = .0002). CONCLUSIONS: Our study demonstrated the comparable postoperative results between the continuous and interrupted technique.

Lung Transplant Type and Donor Age in Idiopathic Pulmonary Fibrosis: A Single Center Study.

BACKGROUD: Idiopathic pulmonary fibrosis (IPF) accounts for a marked proportion of diagnoses on the US lung transplant (LTx) list. The effects of single (SLT) versus double LTx (DLT) and lung donor age on survival in IPF remain unclear and were investigated in this study. METHODS: We retrospectively assessed survival of LTx recipients with IPF at a single institution from February 2012-March 2020. Survival was analyzed and compared between LTx types (SLT and DLT), donor ages, and the combined groups (LTx type & donor age) using Kaplan-Meier survival analysis and compared by log-rank test. P-values less than 0.05 were considered significant. RESULTS: Of 744 LTx patients at our institution, 307 (41.3%) were diagnosed with IPF, of which 208 (67.8%) were SLT, and 97 (31.6%) were DLT (2 excluded patients underwent heart-lung transplantation). There was no significant difference in survival due to LTx type (P = 0.41) or for patients with donor age <50 or ≥50 y (P = 0.46). Once stratified by both LTx type and donor age, analysis showed no significant difference in survival between the four groups (P = 0.69). CONCLUSIONS: With ethical consideration for organ allocation, as the average age of the US population increases, donor lungs aged ≥50 are an increasingly useful resource in LTx. Our findings suggest donor age and LTx type do not significantly affect survival. Therefore, SLT, and donor lungs aged ≥50 ought to be more readily considered as non-inferior options for LTx in patients with IPF.

Preparation and Utilization of Jute-Derived Carbon: A Short Review.

This article summarizes the preparation and applications of carbon derived from jute sticks and fibers that are low-cost, widely available, renewable, and environmentally friendly. Both the fibers and sticks are considered ideal candidates of carbon preparation because they are composed of cellulose, hemicelluloses, and lignin, and contain negligible ash content. Various carbon preparation methods including simple pyrolysis, pyrolysis with chemical and physical activations are discussed. The impacts of several parameters including types of activating agents, impregnation ratio, and temperature on their morphology, surface area, pore size, crystallinity, and surface functional groups are also emphasized. Various treatments to endow functionalization for increasing the practical applicability, such as chemical, physical, and physico-chemical methods, are discussed. In addition, applications of jute-derived carbon in various practical areas, including energy storage, water treatment, and sensors, are also highlighted in this report. Due to the porous fine structure and a large specific surface area, the jute-derived carbon could be considered as a powerful candidate material for various industrial applications. Finally, possible future prospects of jute-derived carbon for various applications are pointed out.

Computed tomography angiography is not accurate in predicting surgical prosthetic aortic valve implant size.

BACKGROUND: Multidetector computed tomography is vital in preoperative sizing for transcatheter aortic valve replacement. The purpose of this study is to determine whether preoperative transcatheter aortic valve replacement multidetector computed tomography accurately predicts surgical aortic valve prosthesis size. METHODS: Between July 2012 and July 2017, 102 patients who underwent surgical aortic valve replacement had preoperative aortic valve sizing by multidetector computed tomography. The aortic annulus diameter calculated using multidetector computed tomography was compared with intraoperative valve sizing during surgical aortic valve replacement. RESULTS: Forty-one (40.2%) of the 102 patients studied had multidetector computed tomography aortic valve measurements that were accurate. Implanted valves were smaller than multidetector computed tomography calculation in 40 patients (39.2%) and were larger in 21 patients (20.6%). Multidetector computed tomography measurements remained inconsistent with intraoperative sizing regardless of aortic annulus diameter. The variance between multidetector computed tomography annulus measurements and intraoperative sizing was statistically significant. CONCLUSIONS: Preoperative aortic annulus measurements by our institutional transcatheter aortic valve replacement multidetector computed tomography protocol differed substantially from surgical implant size. There was no trend toward over nor under sizing for the entire cohort. However, patients with large measured annulus diameter were more likely to have a smaller valve implanted than predicted, and patients with small measured annulus diameter were more likely to have a larger valve implanted than predicted. These results may affect preoperative planning for patients undergoing aortic valve replacement.

Bilateral endophthalmitis and symmetrical peripheral gangrene in a patient with chronic kidney disease on maintenance hemodialysis.

Dialysis patients have greater number of complications due to multiple comor-bidity and access-related infections as well as nosocomial infections due to reduced immunity and more frequent hospitalizations. Endogenous endophthalmitis is a potentially blinding ocular infection occurring in chronically debilitated patients and the use of invasive procedures. Symmetric peripheral gangrene (SPG) is defined as symmetrical distal ischemic damage in two or more sites in the absence of a major vascular occlusive disease. It carries a high mortality rate with a very high frequency of multiple limb amputations in the survivors. However, only a few case reports have described endogenous endophthalmitis in dialysis patients. Concomitant endophthalmitis and disseminated intravascular coagulation (DIC), presenting as SPG, is extremely rare and no such case was found in the literature survey. Herein, we report a very rare association of bilateral endophthalmitis with DIC and SPG in a patient with chronic kidney disease on maintenance hemodialysis.

Etiology and frequency of hospital admissions in maintenance hemodialysis patients in chronic kidney disease.

Chronic kidney disease (CKD) and end-stage renal disease are a global health problem worldwide. In developing countries, it is a particular challenge to deliver optimal hemodialysis (HD) due to prevailing socioeconomic conditions. This has multiple downstream effects, including frequent hospitalizations and increased morbidity. We conducted this retrospective study to identify the etiology of hospital admission in HD patients and to detect the duration and costs associated with their hospitalizations. A total of 42 maintenance HD patients were hospitalized during this time frame and their hospitalizations were studied for the purpose of this study. CKD is growing global public health problem causing socioeconomic impact. Hence, early detection and referral to nephrology services can reduce hospitalization rates after a planned dialysis start thus might improve patients' quality of life.

Factors Influencing Physician Counseling on Cardiovascular Risk.

BACKGROUND AND IMPORTANCE: A significant reduction in cardiovascular disease (CVD) mortality is related to aggressive management of modifiable CVD risk factors. Therefore, patients at increased risk for CVD should not only benefit from standard pharmacotherapy but also from counseling regarding lifestyle behavioral changes. OBJECTIVE: To determine the patient factors that influence provision of cardiovascular risk reduction counseling from physicians, as well as the frequencies of counseling. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a prospective, randomized trial among an underserved inner-city and rural population (n = 388) with a 10% or greater CVD risk (Framingham 10-year risk score). Subjects were followed for 1 year and were seen for quarterly assessments, which included evaluation of weight, blood pressure, lipid, and glucose status. At each of the 4 quarterly visits, subjects were asked if their physician had discussed or made recommendations regarding lifestyle behaviors, specifically diet, weight loss, and exercise. RESULTS: The average patient age was 61.3 ± 10.1 years, average A1c was 6.7 ± 1.6%, average total cholesterol was 201 ± 44 mg/dL. The average body mass index (BMI) was 31.8 ± 6.4 kg/m2, and the average blood pressure was 146 ± 18/82 ±11 mm Hg. Using binary logistic regression analysis, BMI (P < .025) was the only clinical factor related to physician lifestyle counseling. All other risk factors showed no statistical relationship. CONCLUSION: The data indicate that BMI is the major factor associated with whether or not physicians provide counseling regarding nutrition and weight loss. Physicians may be missing important opportunities to influence behavior in patients at high risk for CVD by limiting their focus to obese patients.

Assessing groundwater stoichiometric composition and its suitability in Northwestern Bangladesh / Avaliação de lençol de água quanto a composição estioquiométrica e a sua conveniência do Noroeste do Bangladesh

Groundwater quality analyses included pH, EC, cations (Ca2+, Mg2+, Na+, K+, Zn2+, Cu2+, Mn2+, Fe3+ and As3+), anions (CO32-, HCO3-, NO3-, SO42-, PO43- and Cl-) and TDS of northwestern Bangladesh. The samples contained Ca2+, Mg2+ and Na+ as the dominant cations and HCO3- and Cl- were the dominant anions. Ratios of major cations and anions of water samples suggest the predominance of Ca and Mg-containing minerals over Na-containing minerals. According to TDS and SAR values, all samples were classed as 'freshwater' and 'excellent' categories. The SSP of all waters was under 'excellent' and 'good' classes. All samples were within 'soft' class regarding hardness with 'suitable' RSC. Based on As3+, Zn2+, Mn2+, Fe3+, SO42-, NO3- and Cl- all groundwater samples were within the 'safe' limit for drinking but unsuitable for some industries for specific ions.

As análises de qualidade de Lençol de Água incluíram pH, EC, e os cations,(Ca2+, Mg2+, Na+, K+, Zn2+, Cu2+, Mn2+, Fe3+ e As3+), aníons ( CO32-, HCO3-, NO3-, SO42-, PO43- e Cl-e TDS do noroeste do Bangladesh. As amostras continham Ca2+, Mg2+ e Na+ e como o cations dominante HCO3- e Cl foram os aníons dominantes. Segundo o TDS e valores de SAR, todas as amostras foram classificadas como categorias 'de água doce' e 'excelentes'. O SSP de todas as águas foi nas classes 'excelentes' e 'boas'. Todas as amostras foram dentro da classe 'suave' quanto à dureza com RSC 'conveniente'. Baseado As3+, Zn2+, Mn2+, Fe3+, SO42-, NO3- e Cl- - todas as amostras de lençol de água foram dentro do limite 'seguro' como água de bebida mas impróprias para algumas indústrias que emprega íons específicos.

Factors affecting frequency of patient use of Internet-based telemedicine to manage cardiovascular disease risk.

We examined the frequency of use by patients of a web-based reporting system to monitor and control cardiovascular disease (CVD) risk factors. A total of 192 patients with intermediate or high CVD risk were categorized into four quartiles based on their frequency of use of the telemedicine reporting system over one year. The lowest frequency users (Quartile I) averaged 17 reporting days in one year and the highest frequency users (Quartile IV) averaged 211 reporting days in one year. Factors associated with more frequent use were overall knowledge of CVD (P = 0.014), blood lipids (P = 0.017), smoking (P = 0.036), higher scores in medication self-efficacy (P = 0.016) and higher income (P = 0.002). All quartiles showed trends of decreasing systolic blood pressure from hypertensive (≥140 mm Hg) to pre-hypertensive (<140) ranges. Patients were able to lower CVD risk with as few as two transmissions per month using the telemedicine system. Telemedicine reporting coupled with self-assessment of health status can promote a strong patient-provider partnership for managing the chronic risk factors of CVD.

Present status and future perspectives of heart transplantation.

Heart transplantation has evolved as the "gold standard" therapy, with median survival exceeding 10 years, for patients with endstage heart failure (HF). Advancements in the fields of immunosuppression, infection prophylaxis, and surgical techniques have transformed heart transplantation from what was once considered an experimental intervention into a routine treatment. The number of heart transplants reported to the International Society of Heart and Lung Transplantation registry worldwide has been 3,500-4,000 annually, but has not been increased over the past 2 decades because of donor shortage despite the growing number of patients with HF. This imbalance between the supply of donor hearts and the demand of patients with endstage HF has led to increased use of mechanical circulatory support as destination therapy, because the supply of mechanical devices is virtually unlimited. Although mechanical circulatory support technology is improving, heart transplantation remains the preferred treatment for many patients because of major complications, such as stroke, bleeding and infection, and because of limited quality of life related to the driveline and the need for battery change. Therefore, significant efforts have been made to maximize the number of heart transplants and to ensure good outcomes.

Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome.

BACKGROUND: Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored. METHODS: We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004-2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups. RESULTS: Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001). CONCLUSIONS: Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.

Treatment of patients with intermediate cardiovascular risk: Are clinical measures enough?

AIM: Clinical measures of cardiovascular disease risk (CVD) are important tools for establishing therapy to lower CVD risk. Risk assessment has come under criticism because clinical measures can underestimate or overestimate CVD risk. We assessed CVD risk in 252 subjects without evidence of CVD to establish therapy of one or more risk factors from clinical indications. The subjects all had intermediate CVD risk using the Framingham score. RESULTS: Average age was 59.1 years. 23.8% were smokers, 59.1% were hypertensive, 65.1% had hyperlipidemia. BMI was greater than 30 kg/M(2) in 56% and diabetes was present in 43.7%. In this cohort, 86.9% required therapy for hypertension or hyperlipidemia, and this proportion increased to 95.6% when subjects with diabetes were included. Of the remaining 4.4% (11 subjects), 7 reached intermediate risk based on cigarette smoking and 4 based on age >65 years old. Among diabetics, 94/110 had another risk factor and would require statin and ACE or ARB therapy. CONCLUSIONS: Of subjects at intermediate risk for CVD, 98.4% would not require further testing to decide on therapy to lower CVD risk. Although 16 diabetic subjects had no other risk factors, current guidelines suggest that these subjects should be treated to reduce CVD risk.

Endothelial-dependent flow-mediated dilation in African Americans with masked-hypertension.

BACKGROUND: Office-blood pressure (BP) measurements alone overlook a significant number of individuals with masked-hypertension (office-BP: 120/80-139/89 mm Hg and 24-h ambulatory BP monitoring (ABPM) daytime ≥135/85 mm Hg or night-time ≥120/70 mm Hg). Diminished endothelial function contributes to the pathogenesis of hypertension. To better understand the pathophysiology involved in the increased cardiovascular (CV) disease risk associated with masked-hypertension, we estimated the occurrence, assessed the endothelial function, compared plasma levels of inflammatory markers, white blood cell count (WBC count), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hsCRP) and examined the possible relationship between endothelial function and inflammatory markers in apparently healthy prehypertensive (office-BP: 120/80-139/89 mm Hg) African Americans. METHODS: Fifty African Americans who were sedentary, nondiabetic, nonsmoking, devoid of CV disease were recruited. Office-BP was measured according to JNC-7 guidelines to identify prehypertensives in whom ABPM was then assessed. Fasting plasma samples were assayed for inflammatory markers. Brachial artery flow-mediated dilation (FMD) at rest and during reactive hyperemia was measured in a subset of prehypertensives. RESULTS: Subjects in the masked-hypertension sub-group had a higher hsCRP (P = 0.04) and diminished endothelial function (P = 0.03) compared to the true-prehypertensive sub-group (office-BP: 120/80-139/89 mm Hg and ABPM: daytime <135/85 mm Hg or night-time <120/70 mm Hg). Regression analysis showed that endothelial function was inversely related to hsCRP amongst the masked-hypertensive sub-group (R(2) = 0.160; P = 0.04). CONCLUSIONS: Masked-hypertension was identified in 58% of African Americans which suggests that a masking phenomenon may exist in a sub-group of prehypertensives who also seem to have a diminished endothelial function that could be mediated by an elevated subclinical inflammation leading to the increased CV disease.

Reducing cardiovascular disease risk in medically underserved urban and rural communities.

OBJECTIVES: The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects. BACKGROUND: Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care. METHODS: We randomized 465 subjects without overt CVD, with Framingham CVD risk >10% to NM with 4 visits over 1 year, or NM plus T to facilitate weight, blood pressure (BP), and physical activity reporting. The study goal was to reduce CVD risk by 5%. RESULTS: Three hundred eighty-eight subjects completed the study. Cardiovascular disease risk fell by ≥ 5% in 32% of the NM group and 26% of the T group (P, nonsignificant). In hyperlipidemic subjects, total cholesterol decreased (NM -21.9 ± 39.4, T -22.7 ± 41.3 mg/dL) significantly. In subjects with grade II hypertension (systolic BP ≥ 160 mm Hg, 24% of subjects), both NM and T groups had a similar BP response (average study BP: NM 147.4 ± 17.5, T 145.3. ± 18.4, P is nonsignificant), and for those with grade I hypertension (37% of subjects), T had a lower average study BP compared to NM (NM 140.4 ± 16.9, T 134.6 ± 15.0, P = .058). In subjects at high risk (Framingham score ≥ 20%), risk fell 6.0% ± 9.9%; in subjects at intermediate risk (Framingham score ≥ 10, < 20), risk fell 1.3% ± 4.5% (P < .001 compared to high-risk subjects). Medication adherence was similar in both high- and intermediate-risk subjects. CONCLUSIONS: In 2 underserved populations, CVD risk was reduced by a nurse intervention; T did not add to the risk improvement. Reductions in BP and blood lipids occurred in both high- and intermediate-risk subjects with greatest reductions noted in the high-risk subjects. Frequent communication using a nurse intervention contributes to improved CVD risk in asymptomatic, underserved subjects with increased CVD risk. Telemedicine did not change the effectiveness of the nurse intervention.

Enhanced blood pressure variability in a high cardiovascular risk group of African Americans: FIT4Life Study.

High blood pressure (BP) levels in African Americans elicit vascular inflammation resulting in vascular remodeling. BP variability (BPV) correlates with target organ damage. We aimed to investigate the relationship between inflammatory markers and BPV in African Americans. Thirty-six African Americans underwent 24-hour ambulatory BP monitoring (ABPM). BPV was calculated using the average real variability index. Fasting blood samples were assayed for high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha), and white blood cell (WBC) count. Significant associations between hs-CRP and 24-hour systolic variability (r=0.50; P=.012) and awake systolic variability (r=0.45; P=.02) were identified after adjusting for age, body mass index, and 24-hour mean BP. ABPM variables were compared between the hs-CRP tertile groups. In post-hoc analysis, there was a significant difference in 24-hour and awake periods for both systolic and diastolic variability among the groups. TNF-alpha and WBC count showed no associations with ABPM variables. hs-CRP was associated with systolic variability, and higher levels of hs-CRP were related with greater BPV. Higher inflammatory status influences wider fluctuations in systolic BP, which in turn could facilitate early progression to target organ damage independent of absolute BP levels in African Americans.

Gender differences in cardiovascular risk factors and risk perception among individuals with diabetes.

PURPOSE: The purpose of this study was to examine gender-based differences in cardiovascular risk factors and risk perception among individuals with diabetes. METHODS: The sample consisted of patients with an established history of diabetes who were enrolled in a telemedicine trial to reduce cardiovascular disease (CVD) risk. All subjects had a 10% or greater risk on the Framingham risk index. Assessments included blood pressure, A1C, lipid profile, medication history, and knowledge and risk perception surveys. RESULTS: Data were available for 211 individuals with type 2 diabetes (88 men and 123 women). The women and men did not differ in age, body mass index, or Framingham risk. Only 37.4% of women and 40.9% of men were at an A1C target of <7%. Total cholesterol levels were significantly higher among women, and fewer women were at low-density lipoprotein or blood pressure targets. Knowledge of CVD was similar between the 2 sexes. However, women perceived their risk for CVD to be significantly higher than did men. CONCLUSION: Less favorable cardiovascular risk profiles are observed among women with diabetes as compared with their male counterparts. Multifaceted approaches to both diabetes management and education are needed to target CVD risk reduction among individuals with diabetes.