Medicine and Health Sciences Commons^™

Aspirin Use Following Preeclampsia To Prevent Future Adverse Cardiovascular Outcomes, Kristi Bohlig

Physician Assistant Scholarly Project Posters

• Introduction: Preeclampsia during pregnancy warrants therapy with low dose aspirin. The purpose of this review is to investigate if these women are at increased future risk for cardiovascular morbidity and mortality, and if aspirin therapy prevents future cardiovascular events.

• Research Questions: Do women who had preeclampsia during pregnancy have increased future cardiovascular morbidity and mortality? • Does continued aspirin use in postpartum women, who had preeclampsia during pregnancy; decrease future cardiovascular morbidity and mortality?

• Research Methods: Literature review was conducted utilizing CINAHL, Dynamed plus and PubMed databases.

• Discussion: Many studies have found that preeclampsia does increase …

Comparison Of Rivaroxaban And Warfarin In The Prevention Of Recurrent Venous Thromboembolism, Philip J. Heiden

Physician Assistant Scholarly Project Posters

The purpose of this systematic literature review is to determine the efficacy and safety of rivaroxaban (Xarelto) compared to warfarin (Coumadin), for the long term prophylaxis of recurrent venous thromboembolism (VTE). Rivaroxaban was chosen as the primary representative of factor Xa inhibitors because of its simplistic once a day dosing regimen. The PubMed database was extensively searched, using a variety of key terms, from September 10 to November 30, 2018. Works chosen include propensity-matched cohorts, retrospective studies, systematic reviews, and meta-analyses. All of which were published within the last 10 years; sources dated prior to 10 years were excluded. Studies …

Early Aggressive Insulin Therapy In Type 2 Diabetes, Bryan Johnson

Physician Assistant Scholarly Project Posters

Metformin has been proven beneficial for the first-line treatment of type 2 diabetic mellitus (T2DM) due to its efficacy and low adverse effect profile. Current US guidelines do not address the use of early intensive insulin use in T2DM. Treatment plans are slowly adjusted over the months until the A1C goal is met. Insulin is initiated several years after the time of T2DM diagnosis and utilized as second-line therapy. Dual therapy of insulin and metformin have shown regression of T2DM in certain patient populations. However, the linear relationship between diabetes and cardiovascular disease does not show greater improvement with dual …

Embolus Prevention: Anticoagulant Therapy In Comparison To Watchman's Procedure In Patients With Atrial Fibrillation, Erik Fladmo

Physician Assistant Scholarly Project Posters

• Atrial fibrillation or A-fib is a common cardiac disease that occurs as individuals get older.

• A risk factor of atrial fibrillation is blood clot formation and dislodgement or ‘embolus’ in the left atrium.

• Current treatment methods to prevent clot formation include anticoagulants, as well as a left atrial appendage closure device, The Watchman’s device is the only FDA approved left atrial appendage closure device.

• Study results confirm the rising efficacy and cost effectiveness of Watchman’s device versus long term anticoagulant therapy as well as their adverse effects regarding placement and post procedure; however further randomized control …

Limb Salvage For Diabetic Patients With Peripheral Arterial Disease, Jamie Jesse Johnson

Physician Assistant Scholarly Project Posters

•According to the Center for Disease Control (CDC) (2017), the total number of patients diagnosed with diabetes is exceeding 30.2 million and rapidly increasing.

•According to the CDC (2016), approximately 8.5 million people in the United States have peripheral artery disease (PAD), which includes 12-20% of individuals who are older than age 60.

•According to a study performed by Swaminathan et al. (2014), 186,000 patients underwent lower extremity amputation (LEA). Data also shows that patients undergoing LEA have a mortality rate of 20% noted within one year, and a 40% to 50% mortality rate indicated within 18 months.

•The review …

Systemic Therapy Versus Catheter Directed Techniques For The Treatment Of Acute Massive Pulmonary Embolism, Lawrence Duane Lee

Physician Assistant Scholarly Project Posters

•Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload.

•Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments.

•This literature review researched articles looking at both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term …

The Impact Of Circadian Misalignment On Cardiometabolic Health, Cynthia Marie Mills

Physician Assistant Scholarly Project Posters

The circadian system is important in all living organisms because it generates a 24-hour rhythm for physiological and behavioral processes enabling anticipation and adaptation to daily changes in the environment. The prevalence of cardiometabolic diseases, which are linked to lifestyle choices, has been rising at an alarming rate. Modernization and globalization are two of many factors to blame for lifestyle changes resulting in circadian disruption. The purpose of this literature review is to explore circadian misalignment with regards to its mechanism and impact on cardiometabolic health and to determine possible interventional measures. The primary focus is on lifestyle change, particularly …

The Efficacy And Safety Of Statins In The Primary Prevention Of Cardiovascular Disease, Kayla M. Ashton

Physician Assistant Scholarly Project Posters

Atherosclerotic plaques can form in the blood vessels from particles of cholesterol. These plaques are a major cause of cardiovascular disease and have the ability to result in fatal cardiovascular events. In researching this topic, PubMed, the Cochrane Library, DynaMed, and ClinicalKey were all utilized in finding articles published from 2002 to 2018. There are several organizations with conflicting guidelines recommending the use of statin medications in the primary prevention of cardiovascular disease. The research evaluated discovers data is inconclusive on the benefit of statin medications in this primary prevention as well as the safety of long-term statin use. Some …

Pre-Participation Physical Exams: Are We Doing Enough?, Steven Jacob Pietrusza

Physician Assistant Scholarly Project Posters

•Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities.

•Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States.

•The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the …

The Neuroprotective Effects Of Targeted Temperature Management On Post-Cardiac Arrest Patients, Timothy Hovde

Physician Assistant Scholarly Project Posters

Novel methods of ensuring survival following cardiac arrest and resuscitation are of supreme importance to the medical community. Targeted temperature management (TTM) has become increasingly utilized pre-hospital, in emergency departments, and within intensive care units to increase the likelihood of survival to hospital discharge. TTM has further been used to attempt to improve neurological functioning. The efficacy and mechanism behind TTM remains poorly understood. In several patient populations it also remains unproven. The purpose of this study is to assess the physiological mechanism, survival, neurological recovery and methodology of TTM use and implementation.

Literature review was utilized to assess the …

The Effect Of Statins In Primary Prevention On All-Cause Mortality, Brian Adams

Physician Assistant Scholarly Project Posters

During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.

Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular …

Brugada Syndrome; Preventive Screening Measures To Decrease Associated Cardiac Deaths, Matthew Ryba

Physician Assistant Scholarly Project Posters

• Brugada syndrome is a sodium channel deficiency in the myocardium that can cause arrhythmias and sudden cardiac death. The myocardium deficient sodium channels can be inherited or affected by environment factors such as fever or medications.

• Screening for this syndrome can be challenging because many times the first symptom of Brugada syndrome is cardiac arrest. Though incidents of sudden cardiac deaths are low, sudden cardiac death can impact families and communities.

• In Italy, screening ECG’s is claimed to have reduced sudden cardiac events by 85% (Maron, 2014). Preventing sudden cardiac death in these patients through sensible, reasonable …

Anticoagulation Therapy For The Elderly With Atrial Fibrillation, Rebecca Hoistad

Physician Assistant Scholarly Project Posters

• Atrial fibrillation increases in occurrence as we age with about 9% of patients developing it by age 90. When a patient is diagnosed with atrial fibrillation, one of the drugs that they are prescribed is an anticoagulant. The purpose of this drug is to prevent thrombus formation in addition to preventing an ischemic stroke. Today, there are many options available for anticoagulation therapy. The options include aspirin, vitamin K antagonists like warfarin, factor Xa inhibitors like rivaroxaban and apixaban, direct thrombin inhibitors like dabigatran, and antiplatelet agents such as clopidogrel.

• A review of the literature was done of …

Fructose And Its Contribution To Cardiovascular Disease And Metabolic Syndrome, Jessica Anderson

Physician Assistant Scholarly Project Posters

The incidence of obesity, cardiovascular disease, and combination of symptoms classified as “metabolic syndrome” that eventually leads to type 2 diabetes have risen dramatically over the past few decades. The current dietary guidelines that advised patients to avoid dietary fats were originally developed in the 1960’s. This led the way for food manufacturers to remove fats in processed foods and replace them with sugars, particularly fructose. At the time there was no clinical trial data that definitively supported these guidelines.

The increased use of fructose as a food additive has dramatically increased the per-capita consumption of this sugar. More recent …

Non-Hdl-C Or Apolipoprotein-B Versus Ldl-C Screening For Evaluation And Treatment Of Atherosclerotic Cardiovascular Disease, Grant Coauette

Physician Assistant Scholarly Project Posters

• Lowering low-density lipoprotein cholesterol (LDL-C) concentration in the population has been a goal of researchers and clinicians to prevent atherosclerotic cardiovascular disease (ASCVD).

• Controversy surrounds using [LDL-C] as the primary lipid biomarker to evaluate the risk of cardiovascular events. An article search dating back to 2005 of PubMed and The Cochran Library was conducted.

• The purpose of this investigation was to determine if LDL-C should be the primary lipid biomarker used to determine ASCVD treatment and prevention. This investigation researched other lipid biomarkers and targets to determine clinical relevance and if the level of those markers more …

Serum Biomarkers Compared To Neural Imaging In The Differentiation Of Stroke Etiologies, Kevin Conboy

Physician Assistant Scholarly Project Posters

• Stroke is a leading cause of disability and morbidity and the fourth leading cause of death in the United States, and the second leading cause of death worldwide.

• Early restoration of blood flow is the most effective treatment of ischemic stroke by intravenous thrombolytic therapy within 3-4.5hrs of symptom onset.

• Patient outcomes have been shown to improve with earlier thrombolytics, each 15 minute increment increases survival by 3.0-4.0%.

• Non-contrast CT is the current standard for differentiation of stroke. It is beneficial due to speed of acquisition and its high sensitivity in ruling out hemorrhagic stroke.

• …

Direct Factor Xa Inhibitors Versus Warfarin In Non-Valvular Atrial Fibrillation: Efficacy, Safety, Cost, And Reversibility, Cory D. Jacobs

Physician Assistant Scholarly Project Posters

Atrial fibrillation is a common cause for stroke. Vitamin K antagonists such as warfarin are an effective prophylactic medication to prevent stroke in patients with atrial fibrillation. Warfarin, however, has a narrow therapeutic index, reacts with certain foods, increases bleeding risks, and requires frequent monitoring. New medications have been developed to prevent clot formation while avoiding the negative effects of warfarin. The purpose of this study was to compare direct factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban) versus warfarin in stroke prevention, safety, and cost.

The review of literature analyzed studies comparing warfarin and direct factor Xa inhibitors in patients …

Does Adherence To A Plant-Based Diet Cause A Statistically Significant Decrease In The Risk Of Cardiovascular Events?, Amber H. Johnson

Physician Assistant Scholarly Project Posters

• One of the current problems in many affluent societies is the straightforward access to convenience and fast foods. Although these selections have suitability for today’s fast-paced world, overall nutritional value becomes the martyr of such practices. It is a logical thought that there could be a correlation between this nutritional pattern and the ever-increasing presence of obesity, cardiovascular disease, type 2 diabetes mellitus, hypertension, dyslipidemia, cancer, and other conditions carrying a proverbial death sentence.

• The intent of this review of the literature was to determine the effect a plant-based diet versus an omnivorous diet would have on adults, …

Coronary Artery Calcium Scoring Vs. Exercise Tolerance Testing: Diagnoses And Risk Stratification Of Ascvd, Brittany Anundson

Physician Assistant Scholarly Project Posters

• Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in today’s society and contributes to high rates of mortality involved with heart disease.

• The initial assessment of ASCVD and risk stratification concerning the development of an acute coronary event can be performed in a number of ways.

• Current American Heart Association (AHA) guidelines recommend exercise stress testing (ETT) as the initial, noninvasive evaluation of choice.

• However, the accuracy of this test is highly dependent on the patient’s endurance, body mass index, and artifact, making analyzation difficult.

• Non-contrast cardiac computed tomography (CT) with coronary artery calcium (CAC) scoring …

Screening For Cardiovascular Disease In Children, Jesse Fladmark

Physician Assistant Scholarly Project Posters

Introduction: Cardiovascular disease is one of the leading causes of death in the world with significant burden on the health care system.

Review of Literature: The focus of this paper is to look at previous studies, mostly systematic reviews and metaanalysis, in search of various clinical screening methods in the pediatric population for determining cardiovascular disease risk. Waist to height ratio can be used to screen children for cardiovascular disease with a specificity of 96% when using 0.55 as the cut-off point. An increase in waist circumference along with increased BMI places a child at a much higher risk of …

Pcsk9 Inhibitors: A Review Of The Efficacy, Safety And Current Literature Recommendations, Lacey L. Jandrin

Physician Assistant Scholarly Project Posters

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality in developed counties. It is estimated that 60 million Americans have LDL-C levels > 160 mg/dl. Only about 1/3 of these patients meet treated LDL cholesterol goals of < 70 mg/dl indicating a need for greater control. High dose statins have been the mainstay in treatment of dyslipidemia, however, up to 20% of patients are statin intolerant indicating a need for secondary treatment strategies. This lead to the development of monoclonal antibodies to proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. PCSK9 inhibitors result in decreased destruction of the low-density lipoprotein receptor (LDL-R) which leads to an increase in the transport of LDL-C to its destruction effectively reducing LDL-C levels in the blood. The purpose of this study is to analyze the literature available on the efficacy and safety of new PCSK9 inhibitors. The results of this literature review indicated that PCSK9 inhibitors effectively lowered LDL-C by an average of approximately 50%. The evidence reviewed by this analysis indicate that 70% of patients treated with PCSK9 inhibitors met LDL-C goals. The findings also indicate that the side effects associated with this new class of medications are comparable to current side effects seen with traditional cholesterol lowering agents. The largest side effect seen in up to 10% of patients were injection site reactions and did not require discontinuation of the medication. The results of this analysis indicate that PCSK9 inhibitors may be of benefit in patients who are statin intolerant, do not meet LDL-C goals on traditional statin therapy or have familial hypercholesterolemia. Education in use of injectables, cost and insurance coverage and dosing schedule are likely to be areas of continued research and may affect use of this new class of cholesterol lowering agents.

Impact Of Increasing Glp-1 On Markers Of Inflammation, Glucose Control And Cardiovascular Risk Factors In Patients With Type 2 Diabetes, Kristina Sandstedt

Physician Assistant Scholarly Project Posters

There is a strong established relationship between diabetes and cardiovascular disease. Much of the latest research studies have identified a link between the inflammatory processes and the pathogenesis of both cardiovascular disease and diabetes. Specific inflammatory markers include: Interleukins 1,6,18; C-reactive protein, Fibrinogen, Tumor Necrosis Factor-α, PAI-I and cell adhesion molecules. As a result, there has been an emphasis on identifying therapeutic approaches that would improve both markers of inflammation and glucose control. The endocrine hormones known as incretins, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropicpolypeptide (GIP), are produced in the gastrointestinal tract following ingestion of a meal. In individuals with …

The Da Vinci Robotic Surgical Systems In Atrial Septal Defect Repair, Coronary Artery Bypass Graft And Mitral Valve Repair, Randy Yergenson

Physician Assistant Scholarly Project Posters

Historically, these cardiac interventions have been performed using partial or complete open sternotomy.
1. Coronary artery bypass grafting (CABG)
2. Atrial septal defect (ASD) repair,
3. Mitral valve repair and/or replacement

In 2000, the Federal Food and Drug Administration approved the use of the da Vinci Robotic Surgical System. Less invasive surgical option.

The Efficacy Of Electrocardiograms As A Screening Tool To Detect Cardiac Abnormalities In Young Athletes, Cody William

Physician Assistant Scholarly Project Posters

• Sudden cardiac death (SCD) among athletes can be attributed to increased cardiovascular demands associated with vigorous exercise.

• The majority of athletes who experience sudden cardiac death are asymptomatic.

• Pre-participation history and physicals, (H&P) help to identify underlying cardiovascular disorders with the potential to increase the risk of SCD in an athlete.

• The efficacy of pre-participation H&Ps to identify underlying cardiac etiology has been debated.

• The purpose of this research is to:

---Determine incidence and cause of SCD among athletes (Table 1).

---Determine the efficacy and evidenced-based criteria for the interpretation of ECGs in athletes.

---Evaluate …

Carotid Endarterectomy Versus Carotid Stenting In The Treatment Of Carotid Artery Stenosis, Parker B. Martin

Physician Assistant Scholarly Project Posters

• Carotid artery stenosis secondary to atherosclerotic plaque is a leading cause of CVA in the United States

• Stenosis of the common carotid artery greater than 70% typically needs intervention

• The purpose of this study is to determine which procedure will have the best long term outcomes and prevent re-stenosis of the carotid artery.

Acute Myocardial Infarction: Are We Overlooking Nstemi?, Kevin D. Swenson

Physician Assistant Scholarly Project Posters

• Acute myocardial infarction (AMI) is one of the leading causes of death in the United States.

• The purpose of this study was to examine methods of clinical differentiation between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) and then to compare the various treatment methods and subsequent outcomes in STEMI versus NSTEMI.

• A compilation of systematic reviews, medical journals, practice guidelines, medical texts and meta-analyses were researched for the purpose of this study.

• NSTEMI patients are older, have more comorbidities and present with more atypical symptoms than STEMI patients.

• NSTEMI patients are treated less aggressively …

Alternative Treatment With Red Yeast Rice To Reduce Hyperlipidemia, Lisa Froemke

Physician Assistant Scholarly Project Posters

• First line treatment of cardiovascular disease is lifestyle modification followed by the pharmacologic intervention of HMG-CoA reductase inhibitors or statins

• Statins are commonly associated with intolerable side effects such as myalgia leading to medication non-compliance

• RYR preparations claim to inhibit cholesterol synthesis without causing myalgia

• RYR preparations have naturally occurring monacolins such as monacolin K which is chemically identical to lovastatin

• RYR is not regulated by the FDA leading to questionable manufacturing practices producing varying ingredient composition

• The purpose of this study is to investigate the role RYR in hyperlipidemia treatment compared to statins …

New Age Anticoagulants: A Safer And More Effective Alternative To Warfarin?, Benjamin Johnson

Physician Assistant Scholarly Project Posters

Atrial fibrillation is the most common sustained heart rhythm in the United States with estimated prevalence rates of 8.8/100 (Wolf, Abbott, & Kannel, 1991). The largest risk for patients with atrial fibrillation is that of ischemic stroke from embolization of an atrial clot, thus the long standing treatment for this arrhythmia is aggressive anticoagulation. For decades this has been accomplished with the use of warfarin, however, the increased risk of hemorrhage combined with the inconvenience of weekly blood testing has prompted the development of potentially safer and more effective alternatives. A systematic review of the literature identified studies that examined …