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Letter To The Editor: Restarting Warfarin After A Gastrointestinal Bleed, Lauren Smith 2016 Wayne State University

Letter To The Editor: Restarting Warfarin After A Gastrointestinal Bleed, Lauren Smith

Clinical Research in Practice: The Journal of Team Hippocrates

This letter addresses the dilemma of restarting anticoagulation after recent gastrointestinal bleeding.


Association Of Lipid-Related Genetic Variants With The Incidence Of Atrial Fibrillation: The Afgen Consortium, Faye L. Norby, David D. McManus 2016 University of Minnesota, Minneapolis

Association Of Lipid-Related Genetic Variants With The Incidence Of Atrial Fibrillation: The Afgen Consortium, Faye L. Norby, David D. Mcmanus

David D. McManus

BACKGROUND: Several studies have shown associations between blood lipid levels and the risk of atrial fibrillation (AF). To test the potential effect of blood lipids with AF risk, we assessed whether previously developed lipid gene scores, used as instrumental variables, are associated with the incidence of AF in 7 large cohorts.

METHODS: We analyzed 64,901 individuals of European ancestry without previous AF at baseline and with lipid gene scores. Lipid-specific gene scores, based on loci significantly associated with lipid levels, were calculated. Additionally, non-pleiotropic gene scores for high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc) were calculated using ...


Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. McManus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra 2016 Massachusetts General Hospital

Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. Mcmanus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra

David D. McManus

BACKGROUND: The epidemiology of atrial fibrillation (AF) without comorbidities, known as 'lone AF', is uncertain. Although it has been considered a benign condition, we hypothesized that it confers a worse prognosis compared with a matched sample without AF.

METHODS: We described the proportion of AF without comorbidities (clinical, subclinical cardiovascular disease and triggers) among the entire AF sample in Framingham Heart Study (FHS). We compared AF without comorbidities with typical AF, and age-, sex- and cohort-matched individuals without AF, using Cox proportional hazards analysis in relation to combined cardiovascular events (stroke, heart failure, myocardial infarction), and mortality.

RESULTS: Of 10 ...


Acute Appendicitis: A Potential Complication Of Continuous-Flow Left Ventricular Assist Device Support, Joshua S. Roark, Akinniran A. Abisogun, Jason N. Katz 2016 University of North Carolina

Acute Appendicitis: A Potential Complication Of Continuous-Flow Left Ventricular Assist Device Support, Joshua S. Roark, Akinniran A. Abisogun, Jason N. Katz

The VAD Journal

Acute appendicitis, while common in younger patients, is an unusual cause for hospitalization among older adults. We report a case series of 3 individuals who had been previously implanted with a continuous-flow left ventricular assist device (CF-LVAD) for end-stage heart failure, and who subsequently developed acute appendicitis. Both axial-flow technology and nonpulsatile systemic blood flow have been implicated as potential causes for bleeding and thrombosis in contemporary LVAD populations(1-3). This case series represents the first report of acute appendicitis as an adverse event following LVAD implantation and represents a patient demographic that would historically be at very low-risk for ...


Pathway By Which Vagus Nerve Stimulation Of B Fibers Affects Heart Rate, Kelsey Wasilczuk, Matthew Ward, Pedro Irazoqui 2016 Purdue University

Pathway By Which Vagus Nerve Stimulation Of B Fibers Affects Heart Rate, Kelsey Wasilczuk, Matthew Ward, Pedro Irazoqui

The Summer Undergraduate Research Fellowship (SURF) Symposium

Heart failure (HF) affects over 5 million adults in the United States. Many HF patients have a high resting heart rate, which is correlated with a high mortality rate. In recent years, vagus nerve stimulation (VNS) has become an increasingly researched therapy to reduce the resting heart rate of HF patients. However, current dosage given during VNS is increased incrementally at the doctor’s office until side effects present themselves in a patient. In addition, the means by which the therapy works is not completely understood. To better understand the therapy’s mechanisms, the right cervical vagus nerve of several ...


Herpes Zoster And Cardiovascular Events In Adults: A Systematic Review, Nathaniel A. Erskine, Hoang Tran, Len L. Levin, Christine M. Ulbricht, Joyce D. Fingeroth, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Herpes Zoster And Cardiovascular Events In Adults: A Systematic Review, Nathaniel A. Erskine, Hoang Tran, Len L. Levin, Christine M. Ulbricht, Joyce D. Fingeroth, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

Background: Stroke and myocardial infarction have been reported to occur after the development of herpes zoster (shingles), a common and preventable disease.

Purpose: To evaluate literature describing the association between herpes zoster and its subtypes with the occurrence of cardiovascular events.

Data Sources: PubMed, SCOPUS (Embase), OAIster, Google Scholar (searched in January 2016)

Study Selection: Studies published up to January 2016 examining the association between herpes zoster or subtype of herpes zoster with the occurrence of cardiovascular events, including stroke, transient ischemic attack, or an acute coronary event, were selected. Case reports, case studies, and studies of non-general adult populations ...


Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. McManus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. Mcmanus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg

Molly E. Waring

Background: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome (ACS).

Methods: We studied 2,174 patients discharged from the hospital after an ACS at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments ...


Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones 2016 Harvard Medical School

Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones

Catarina I. Kiefe

BACKGROUND: Cross-sectional clustering of metabolic risk factors for cardiovascular disease in middle-aged adults is well described, but less is known regarding the order in which risk factors develop through young adulthood and their relation to subclinical atherosclerosis.

METHOD AND RESULTS: A total of 3178 black and white women and men in the Coronary Artery Risk Development in Young Adults study were assessed to identify the order in which cardiovascular disease risk factors including diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol or high triglyceride levels), hypercholesterolemia (high total or low-density lipoprotein cholesterol), and obesity develop. Observed patterns of risk factor development ...


Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg 2016 University of Colorado

Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND: Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized.

METHODS AND RESULTS: We studied 2954 patients with left ventricular ejection fraction < /=0.35 undergoing first-time implantable cardioverter-defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged > 65 years. In a median follow-up of 2.4 years, outcome rates per 1000 patient-years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure-related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ...


Cardiovascular Health Awareness And The Effect Of An Educational Intervention On School-Aged Children In A Rural District Of India, Madhab Ray, Santanu Guha, Meghna Ray, Anita Kundu, Bipasha Ray, Kaushik Kundu, Santanu Goswami, Deepak Bhatt, Harry P. Selker, Robert J. Goldberg 2016 Tufts University

Cardiovascular Health Awareness And The Effect Of An Educational Intervention On School-Aged Children In A Rural District Of India, Madhab Ray, Santanu Guha, Meghna Ray, Anita Kundu, Bipasha Ray, Kaushik Kundu, Santanu Goswami, Deepak Bhatt, Harry P. Selker, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND AND OBJECTIVES: India is the second most populous country in the world and two-thirds of its population is less than 35 years old. This survey was conducted to assess the level of health awareness of cardiovascular disease in adolescent school-aged children 14-16 years old, with the goal of establishing school-based health education and development of heart-healthy lifestyle practices.

METHODS: A school-based survey was conducted in the rural district of West Midnapore, India between June and July of 2014. This involved a pre-evaluation of cardiovascular disease (CVD) health awareness, a short presentation on CVD, and a post-evaluation of CVD health ...


Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg 2016 University of Massachusetts Medical School

Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg

Jeroan J. Allison

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and ...


Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak 2016 James Madison University

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations ...


Long-Term Activation Of The Innate Immune System In Atherosclerosis, Anette Christ, Siroon Bekkering, Eicke Latz, Niels P. Riksen 2016 University of Massachusetts Medical School

Long-Term Activation Of The Innate Immune System In Atherosclerosis, Anette Christ, Siroon Bekkering, Eicke Latz, Niels P. Riksen

Open Access Articles

Efforts to reverse the pathologic consequences of vulnerable plaques are often stymied by the complex treatment resistant pro-inflammatory environment within the plaque. This suggests that pro-atherogenic stimuli, such as LDL cholesterol and high fat diets may impart longer lived signals on (innate) immune cells that persist even after reversing the pro-atherogenic stimuli. Recently, a series of studies challenged the traditional immunological paradigm that innate immune cells cannot display memory characteristics. Epigenetic reprogramming in these myeloid cell subsets, after exposure to certain stimuli, has been shown to alter the expression of genes upon re-exposure. This phenomenon has been termed trained innate ...


Air Pollution, Pulmonary Oxidative Stress, And The Endothelin System In The Development Of Cardiovascular Injury., Jordan B. Finch 2016 University of Louisville

Air Pollution, Pulmonary Oxidative Stress, And The Endothelin System In The Development Of Cardiovascular Injury., Jordan B. Finch

UofL Electronic Theses and Dissertations

The goal of this project was to examine the role of endothelin-1 (ET-1) as a mediator in the pathway between air pollution exposure and the development of vascular injury. A human cohort and male mice (C57BL/6 and ecSOD-Tg) were used to evaluate changes in the ET-1 system in response to exposures of fine particulate matter (PM2.5). Human ET-1 levels were significantly associated with environmental factors and markers of vascular change, but were decreased with increased PM2.5. No association was seen between ET-1 and endothelial progenitor cells (EPCs) except for EPC-4, possibly indicating a regulatory relationship with this ...


Statin Therapy For Elderly Patients Should Be Assessed For Each Individual, Raymond Gong 2016 Wayne State University School of Medicine

Statin Therapy For Elderly Patients Should Be Assessed For Each Individual, Raymond Gong

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623-30. doi:10.1016/S0140-6736(02)11600-X


Ultrasound-Guided Intralesional Bleomycin Injection (Ibi) For Treatment Of Cutaneous Hemangiomas And Vascular Malformations, Yousuf Memon, Nuzhat I. Malik, Naveed Anjum, S. Kamran Ahmed, Sadaf Saeed 2016 The Indus Hospital

Ultrasound-Guided Intralesional Bleomycin Injection (Ibi) For Treatment Of Cutaneous Hemangiomas And Vascular Malformations, Yousuf Memon, Nuzhat I. Malik, Naveed Anjum, S. Kamran Ahmed, Sadaf Saeed

The Journal of Global Radiology

Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations.

Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ < 10% reduction].

Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were ...


Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller 2016 College of Nursing and Health Innovation, Arizona State University

Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller

Journal of Health Disparities Research and Practice

Introduction: Life style behaviors contribute to poor health among older Americans Indians/Alaska Native (AI/AN) in the United States, with low levels of physical activity (PA) particularly tied to the chronic disease profile of this population. Searched reviews of physical activity among AI/ANs are limited in assessing prevalence and correlates to PA among older adults > 40 years.

Methods: A literature search of reported physical activity studies among older AI/AN was assessed for prevalence and predictive factors associated with levels of physical activity.

Results: Fourteen studies were included in this review that either specifically quantified the amount of ...


Twenty-Five Year Secular Trends In Lipids And Modifiable Risk Factors In A Population-Based Biracial Cohort: The Coronary Artery Risk Development In Young Adults (Cardia) Study, 1985-2011, Pamela J. Schreiner, David R. Jacobs Jr, Nathan D. Wong, Catarina I. Kiefe 2016 University of Minnesota

Twenty-Five Year Secular Trends In Lipids And Modifiable Risk Factors In A Population-Based Biracial Cohort: The Coronary Artery Risk Development In Young Adults (Cardia) Study, 1985-2011, Pamela J. Schreiner, David R. Jacobs Jr, Nathan D. Wong, Catarina I. Kiefe

Open Access Articles

BACKGROUND: Cross-sectional analyses suggest that total and low-density lipoprotein cholesterol (LDL-c) trends that had been declining are now reversing. We examined longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine secular trends in total cholesterol, LDL-c, high-density lipoprotein cholesterol (HDL-c), and triglycerides over 25 years. We also assessed whether modifiable lifestyle factors (body mass index, physical activity, alcohol consumption, smoking, and lipid-lowering medications) are associated with these trends.

METHODS AND RESULTS: CARDIA recruited 5115 black and white men and women ages 18 to 30 years from 4 US communities in 1985-1986, and re-examined them ...


Kawasaki Disease In Pediatric Patients, Cassandra F. Krinn 2016 Otterbein University

Kawasaki Disease In Pediatric Patients, Cassandra F. Krinn

Master of Science in Nursing (MSN) Student Scholarship

Kawasaki Disease (KD) is an idiopathic, multi system disorder that is characterized by vasculitis of the arteries, capillaries, and veins. It typically affects children 5 years old or younger and is predominately seen in male children of Japanese decent. The inflammation of the blood vessels seen makes Kawasaki disease the leading cause of acquired heart disease in children, with 20% of those affected developing coronary artery aneurysms, cardiac arrhythmias, and heart failure. Diagnosis is based on criteria including presence of fever for 5 days, bilateral conjunctivitis, erythema of the lips and oral mucosa, changes in extremities, rash, and cervical lymphadenopathy ...


Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. McManus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra 2016 Massachusetts General Hospital

Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. Mcmanus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra

UMass Center for Clinical and Translational Science Supported Publications

BACKGROUND: The epidemiology of atrial fibrillation (AF) without comorbidities, known as 'lone AF', is uncertain. Although it has been considered a benign condition, we hypothesized that it confers a worse prognosis compared with a matched sample without AF.

METHODS: We described the proportion of AF without comorbidities (clinical, subclinical cardiovascular disease and triggers) among the entire AF sample in Framingham Heart Study (FHS). We compared AF without comorbidities with typical AF, and age-, sex- and cohort-matched individuals without AF, using Cox proportional hazards analysis in relation to combined cardiovascular events (stroke, heart failure, myocardial infarction), and mortality.

RESULTS: Of 10 ...


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