Cardiovascular Diseases Commons^™

Assessing The Association Between Total Cholesterol And Hospitalized Myocardial Infarction In Women Ages 32-70: An Analysis Of The Framingham Heart Study, Jolene L. Stapleton Duree

Capstone Experience: Master of Public Health

Objective

Heart disease is the leading cause of death in women that may go undiagnosed due to unexpected symptoms. The purpose of this analysis was to assess the effect of total cholesterol on the odds of hospitalized myocardial infarction (MI).

Methods

This analysis used a sample of 2,445 women from the Framingham Heart Study, an observational prospective cohort study. The exposure was total cholesterol, and the outcome was hospitalized MI. Logistic regression was used to estimate crude and adjusted odds ratios (OR). The adjusted models controlled for age, blood pressure, and diabetes. Effect modification by diabetes status was evaluated in …

Pumping Iron, Straining Hearts: Androgen Building Cardiomyopathy In A Middle Aged Bodybuilding Enthusiast, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

A 46-year-old bodybuilder presenting with new onset dyspnea found to have a new onset non-ischemic cardiomyopathy (CM) attributed to exogenous trenbolone and testosterone use. Steroid cessation and guideline-directed heart failure therapy led to notable recovery in left ventricular function supported by global longitudinal strain, ejection fraction and symptomatology.

Anabolic steroid-induced CM involves multiple mechanisms including lipid disturbances, hypertrophy, reduced receptor sensitivity, and cell damage. This case emphasizes the importance of recognizing anabolic steroid misuse as a potential cause of non-ischemic cardiomyopathy in middle aged men. With prompt discontinuation of steroids, remained abstinence and early initiation of guideline-directed medical therapy, myocardial …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Identifying Barriers To Healthcare Access And Utilization Experienced By Lgbtq+ Adults With Chronic Diseases Through The Lens Of The Social Ecological Model, Devin Mottier

Capstone Experience: Master of Public Health

The purpose of this literature review is to comprehensively examine and synthesize existing research on present barriers to health access and utilization that contribute to the disparities in chronic disease prevalence within the adult LGBTQ+ population. In the context of this review, the social-ecological model (SEM) was used to describe the nuanced and multifaceted nature of healthcare access and utilization. This literature review was based upon the following question: ‘Using the social-ecological model, what are the barriers to health access and utilization that contribute to high rates of chronic disease in LGBTQ+ adults?’ Outcome measures of interest included the following …

Oxidative Damage Together With Post-Occlusive Re-Oxygenation Kinetics, In Calf Muscle, Implicate Microvessels In The Myopathy Of Peripheral Artery Disease, Molly Schieber

Theses & Dissertations

Background:Peripheral Artery Disease (PAD) is characterized by calf muscle fibrosis and myofiber oxidative damage (OxD). Our laboratory has demonstrated architectural changes of calf-muscle microvessels (

Methods:Gastrocnemius biopsies were collected from controls, patients with Stage II PAD, and Stage IV patients with limb-threatening ischemia. Carbonyl adducts (CA; oxidative damage), and Heme Oxygenase-1 (HO-1; anti-OxD in microvessels) were quantified in microvessels (

Results: Post-occlusive re-oxygenation of calf muscle was slowed in Stage II patients versus controls. Kinetic parameters correlated poorly with Ankle-Brachial Index. Microvessel CA was increased in pre- and post-exercise Stage II patients and in Stage IV patients versus …

An Analysis Of The Genetic And Environmental Mechanisms Behind Aortic Aneurysm Development And Inhibition, Kathryn E. Jespersen

Theses & Dissertations

Aortic aneurysm is a widespread condition, characterized by dilation and weakening of the aortic vessel wall. Dissection and rupture of the aorta due to uncontrolled aneurysm progression carries a high risk of death. Although both thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA) share similar risks of rupture and mortality, the pathophysiology of each disease is unique. TAA is a hallmark feature of Marfan syndrome (MFS), a connective tissue disorder characterized by malformation of functional elastic fibers in the aortic extracellular matrix (ECM). This malformation of elastic fibers is attributed to mutation of the gene encoding the fibrillin-1 protein, …

Building An Artificial Intelligence Framework For Hypertension Diagnosis: A Use Case Of The Problem List Curation, Ketemwabi Yves Shamavu

Theses & Dissertations

Hypertension is the world's leading factor in cardiovascular disease. Forty-seven percent or close to one in two Americans aged 18 and older are affected. It predicts approximately a thousand deaths per day. Based on recent statistics from the Centers for Disease Control and Prevention, one in three patients with hypertension does not know they are hypertensive. Seventy-five percent of hypertensive patients have uncontrolled hypertension - meaning that they are not treated to target. While there is extensive literature on hypertension diagnosis and management, there is an apparent gap in understanding and acknowledging that a person is hypertensive. Moreover, blood pressure …

Fortuitous Diagnosis Of Total Anomalous Pulmonary Venous Return In A Newborn With Hypoglycemia, Joseph Maes, Terence Zach

Child Health Research Institute Pediatric Research Forum

No abstract provided.

Health Service Utilization And Expenditure In Cardio-Metabolic Conditions In The United States Adults, Kavita Mosalpuria

Theses & Dissertations

Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic …

Cardioprotective Roles Of Hydrogen Sulfide Donor Treatment In Diabetic Cardiomyopathy, Sumit Kar

Theses & Dissertations

Diabetes mellitus (DM) increases the risk of heart failure 2-4-fold. Intensive glycemic control does not abate this risk in DM patients, suggesting that DM-induced heart failure is beyond hyperglycemia. DM silently induces cardiac muscle disorder termed diabetic cardiomyopathy (DMCM), which progresses to heart failure. The objective of this dissertation is to understand the mechanistic underpinnings of DMCM to develop new solutions to diagnose and treat heart failure in DM.

The heart pumps blood due to the contraction and relaxation of terminally differentiated cardiomyocytes with limited regenerative capacity. The DM environment of hyperglycemia, hyperlipidemia, and inflammation causes cardiomyocyte death and leads …

New Onset Murmur Or Hamman’S Sign: Mid-Systolic Click In A Suspected Case Of Connective Tissue Disorder, Amanda Dave, Jodi Cantrell

Graduate Medical Education Research Journal

We present the case of a 15 y/o previously healthy male who presented to CHMC from an OSH with a 3 day history of shortness of breath, audible clicking noise, and chest discomfort after playing at the batting cages 4 days prior. No history of trauma. He was transferred to CHMC for further evaluation after identification of a pneumothorax on chest CT performed at OSH.

With respect to family history, the patient is one of 8 children. Of note, per discussion with family, his older siblings are all tall and have some connective tissue anomalies. Two siblings were noted to …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

The Role Of Central Ace2 And Nrf2 In Sympatho-Excitation: Responses To Central Angiotensin Ii, Anyun Ma

Theses & Dissertations

Sympatho-excitation is a key characteristic in cardiovascular diseases such as chronic heart failure (CHF) and primary Hypertension (HTN). Evidence suggests that increased sympathetic tone is closely related to activation of the Renin-Angiotensin-Aldosterone system (RAAS) in the central nervous system. An underlying mechanism for sympatho-excitation is thought to be oxidative stress resulting from Angiotensin II (AngII) type 1 receptor (AT1R) activation. Over the past several decades, pharmacological targeting of components of the RAAS have been used as standard therapy in CHF and HTN. However, additional therapeutic strategies are necessary to control these diseases. Oxidative stress is regulated, in part, by the …

Defining The Role Of Tyrosine Phosphorylation In The Regulation Of Connexin43 In Cardiac Diseases, Li Zheng

Theses & Dissertations

Connexins are integral membrane proteins that oligomerize to form gap junction channels. Ions and small molecules diffuse intercellularly through these channels, allowing individual cellular events to synchronize into the functional response of an entire organ. Gap junction channels composed of Connexin43 (Cx43) mediate electrical coupling and impulse propagation in the normal working myocardium. In the failing heart, Cx43 remodeling (decreased expression, altered phosphorylation state, loss at intercalated discs, and increased presence at lateral membranes) contributes to rhythm disturbances and contractile dysfunction. While there is considerable information regarding key interactions of Cx43 in the regulation of gap junction channels, unfortunately, the …

Evaluation Of The Role Of Microvascular Pathology On Peripheral Artery Disease, Constance Mietus

Theses & Dissertations

Background: Peripheral Artery Disease (PAD) begins with atherosclerotic narrowing of arteries, including those that supply the legs. Individuals with PAD experience pain during walking, which becomes increasingly limiting. Studies from our group and others have shown that a myopathy is present in the skeletal muscle of PAD patients, and is characterized by myofiber degeneration, fibrosis, and remodeling of vessels ranging from 50 – 150 mm in diameter. However, microvascular pathology, particularly of the smallest microvessels (5 – 15 mm in diameter) remains poorly characterized. Furthermore, little is known about the relationships between microvascular architecture, microperfusion, and patient walking performance. We …

A Study Of Acoustically Activated Nanodroplets, Songita Choudhury

Theses & Dissertations

Current treatment of acute myocardial infarction (AMI), which is the main pathophysiological event leading to death in the United States, has advanced considerably with the introduction of emergent percutaneous interventions, but there remains an urgent need for novel techniques to rapidly and accurately detect infarcted or ischemic tissue that results from AMI. Ultrasound contrast agents, also known as microbubbles (MB), have become commonplace in echocardiography. However, MBs are purely intravascular tracers and unable to cross endothelial barriers due to size. The limitations of MBs, namely size and short circulation times within the human body, led to the development of phase-change …

The Development Of Transforming Growth Factor-Beta 1 Associated Fibrosis In The Gastrocnemius Of Peripheral Artery Disease Patients And Response To Revascularization And Supervised Exercise Therapies, Duy M. Ha

Theses & Dissertations

Peripheral Artery Disease (PAD) affects over 200 million people worldwide with a 5-year mortality rate as high as 30%. Atherosclerotic blockages impair blood flow to the lower limbs, causing ischemic leg pain and dysfunction upon exercise that later progresses to ulcerations and gangrene and often requires amputation. The standard therapies, revascularization and exercise, allow patients to walk further and longer but are at best maintained short-term. One explanation may be the development of myopathic changes in the limb that progress despite improved hemodynamics—a paradigm shift in the classic view of PAD pathophysiology as solely a mismatch between blood supply and …

Leisure Time Physical Activity Preferences, Behaviors, And Hypertension: Evidence From The China Health & Nutrition Survey, 2004-2011, Junmin Zhou

Theses & Dissertations

Background: Physical activity has been continuously declining in China. At the same time, prevalence of hypertension has dramatically increased. The associations between leisure time physical activity preference, behavior, and development of hypertension in Chinese adults remained not fully understood and few studies have examined these associations using longitudinal data.

Objectives: This dissertation examined the interrelationships among leisure time activity preference, behavior, and the incidence of hypertension using longitudinal data from 2004 to 2011 in the China Health and Nutrition Survey. It also assessed the urban-rural disparities.

Methods: A total of 2,687 adults were included in the analysis. Multivariate logistic regressions …

Genetic Predisposition And M1 Macrophage Polarization Created By Elastin-Derived Peptides Drive Abdominal Aortic Aneurysm Formation, Matthew A. Dale

Theses & Dissertations

Abdominal aortic aneurysm (AAA) is a dynamic vascular disease characterized by inflammatory cell invasion and extracellular matrix (ECM) degradation. Evidence has demonstrated a profound influence of genetic background on AAA formation. The work presented herein discusses two studies: the first demonstrates how genetic components can enhance the susceptibility to AAA formation and the second demonstrates how ECM degradation enhances AAA progression by influencing inflammatory cell phenotypes. An understanding of the pathways involved in AAA pathogenesis can help not only to identify potential patients at risk of AAA development, a heritable disease in which the incriminating component has yet to be …