Physiological Risk Factors Research Articles

Medication Adherence and its Related Factors in Patients Undergoing Coronary Artery Angioplasty.

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. Results: The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.

Five-week yin yoga-based interventions decreased plasma adrenomedullin and increased psychological health in stressed adults: A randomized controlled trial.

BackgroundNon-communicable diseases (NCDs, e.g. cardiovascular disease) are responsible for high rates of morbidity and the majority of premature deaths worldwide. It is necessary to develop preventative interventions that can reduce the associated risk factors of NCDs. Researchers have found that the biomarker adrenomedullin (ADM) becomes elevated years before the onset of NCDs and might play an important role in their development. ADM has also been linked to psychological problems such as stress, anxiety, and depression, which are known risk factors of NCDs. In this randomized controlled trial, we examined whether participating in a five-week yoga intervention reduces ADM and increases psychological health in middle-aged adults who self-report as moderately to highly stressed, but who otherwise exhibit no physical complaints.MethodsOne hundred and five adults (78% women; mean age = 53.5, SD = 6.7) were randomly assigned to (1) a five-week Yin yoga intervention, (2) a five-week intervention combining Yin yoga with psychoeducation and mindfulness practice (called the YOMI program), or (3) a control group who did not practice yoga or mindfulness for five weeks.ResultsCompared to the control group, we observed significantly greater pre-post reductions in plasma ADM levels (p < .001), anxiety (p ≤ .002), and sleep problems (p ≤ .003) in both intervention groups. Furthermore, the YOMI group exclusively showed significantly greater pre-post reductions in stress (p = .012) and depression (p = .021) compared to the control group. Significant correlations (p < .05) were found between pre-post reductions in ADM and anxiety symptoms (p = .02) and depression (p = .04) in the entire sample.ConclusionThe five-week Yin yoga-based interventions appeared to reduce both the physiological and psychological risk factors known to be associated with NCDs. The study suggests that incorporating Yin yoga could be an easy and low-cost method of limiting the negative health effects associated with high stress.Trial registrationClinicalTrials.gov NCT03428542

Propensity for adverse pregnancy outcomes in African-American women may be explained by low energy expenditure in early pregnancy

African-American (AA) women have poorer pregnancy outcomes, and studies in nonpregnant women suggest a different etiology of weight gain in AA compared with white women. We hypothesized that physiologic factors such as low energy expenditure and physical activity would be present in AA compared with white women in pregnancy. We aimed to identify physiologic risk factors for disordered energy balance in AA and white women early in pregnancy. This was a cross-sectional study in 66 pregnant women with obesity, between 14 and 16 wk of gestation. Energy intake was calculated using the intake-balance method. Energy expenditure was measured in free-living conditions [total daily energy expenditure (TDEE)] over 7 d with the use of doubly labelled water and during sleep [sleeping EE (SleepEE)] in a room calorimeter. Body composition was measured by air displacement plethysmography and physical activity by accelerometers. Markers of metabolic health were obtained from fasting blood and urine. AA (n=34) and white (n=32) women were comparable in age (mean ± SEM: 27.7±0.6 y), enrollment body mass index [mean ± SEM (in kg/m2): 36.9±0.7], and body fat (mean ± SEM: 45.0%±0.6%). AA women had more fat-free mass (P=0.01) and tended to be more insulin-resistant (homeostasis model assessment of insulin resistance, P=0.06). Energy intake was significantly lower in AA than in white women (2499±76 compared with 2769±58 kcal/d, P=0.001), although absolute TDEE was comparable (AA: 2590±77 kcal/d; white: 2711±56 kcal/d; P=0.21). After adjusting for body composition, TDEE was significantly lower in AA women (-231±74 kcal/d, P=0.003), as was SleepEE (-81±37 kcal/d, P=0.03). Physical activity, substrate oxidation, and metabolic biomarkers (triiodothyronine and thyroxine concentrations, catecholamine excretion) were not significantly different between groups. Body mass-adjusted energy expenditure is significantly lower in AA than in white pregnant women. Energy intake recommendations for pregnancy do not consider this difference and may therefore overestimate energy requirements in AA women. This may lead to unintentional overeating and contribute to the disparity of excess gestational weight gain and postpartum weight retention that is more prevalent in AA women. This trial was registered at clinicaltrials.gov as NCT01954342.

Abstract P-520: PHYSIOLOGIC RISK FACTORS ASSOCIATED WITH FUNCTIONAL OUTCOMES IN PEDIATRIC POST-TRAUMATIC CEREBRAL VASOSPASM

Aims & Objectives: This study examined the physiologic risk factors associated with post-traumatic cerebral vasospasm and poor outcome in children with acute traumatic brain injury. Methods Prospective single center study of previously health (N=60) children ages 5 days to 15 years of age admitted to hospital for an acute TBI. Data include physiologic (temperature, blood pressure, intracranial pressure, serum glucose) data, seizure and CV activity and genetic sampling over 8 days of hospitalization. Functional outcomes were measured at discharge and at 4-week follow-up using the Glasgow Outcome Scale-Extended, Pediatrics (GOS-E Peds). Results Our study included 26 females (43%) and 34 males (57%) with a mean age was 5.9 years, of which 43% of participants experienced an occurrence of CV (anterior or posterior). A total of 62 CV events were identified (Table 1) with subarachnoid hemorrhage being the most prevalent lesion. CV occurred within the first 48 hours of hospitalization. CV was associated with the number of seizures (p-value = 0.042) when adjusted for injury severity. In addition, CV in the anterior circulation was associated with occurrences of hypotension (p-value = 0.016) and hypothermia (p-value = 0.028). The presence of a physiologic instability also showed proportionally poorer GOS-E eds outcomes at both measurement time points. Conclusions We identified that physiologic instability was associated with post-traumatic CV and poorer outcomes in our TBI patients. Although more research is needed to better define these relationships, clinically the opportunity to improve outcomes in patients with TBI should include the evaluation for post-traumatic CV and management of physiologic instability.

Risk of Cardiovascular Disease in American Firefighters

Cardiovascular disease (CVD) is the most common cause of job-related mortality among firefighters in the United States. Although age, family history, and work environments cannot be controlled, other predictors are modifiable. If solutions are to be implemented, it is important to know which health parameters are responsible for the elevated CVD risk in this population. PURPOSE: To examine the cardiovascular health of California firefighters. METHODS: We measured physiological CVD risk factors in 35 firefighters from Northern California. Assessments were age, anthropometry, blood lipids, blood pressure, and blood glucose. Risk factors were summed according to the American College of Sports Medicine guidelines. We evaluated the frequency of individual risk factors and used regression analyses (logistic, negative binomial, and linear as appropriate) to test the effect of age on risk. RESULTS: Firefighters were 33.5 ± 11.8 years old, had a body mass index (BMI) of 26.6 ± 3.4, body fat percent (BF%) of 21.2 ± 6.0%, waist circumference (WC) of 90.3 ± 10.4 cm, and waist-hip ratio of 0.87 ± 0.10. Systolic blood pressure (SBP) was 122.5 ± 8.0 mmHg, diastolic pressure (DBP) was 78.1 ± 10.3 mmHg, fasted blood glucose (FBG) was 98.5 ± 14.3 mg/dL, LDLs were 128.9 ± 40.1 mg/dL, HDLs were 31.6 ± 12.5 mg/dL, triglycerides were 116.8 ± 90.3, and the average number of risk factors was 1.8 ± 1.2. There were 32 firefighters (91.4%) with ≥ 1 risk. The proportion of at-risk firefighters for each variable was: lipid profile (77.1%), obesity (65.7%), FBG (37.1%), blood pressure (34.3%), and age (14.3%). Most of the lipid profile was met by low HDLs (65.7% of all firefighters). Age was a significant predictor of BMI (p=0.001), BF% (p=0.003), WC (p=0.001), and waist-hip ratio (p=0.047), but not SBP (p=0.553), DBP (p=0.590), FBG (p=0.961), HDLs (p=0.369), LDLs (p=0.593), or triglycerides (p=0.688). Increased age significantly predicted an increased number of CVD risk factors (p=0.003). CONCLUSION: As firefighters advanced in age, they experienced elevations in CVD risk, mostly as a consequence of increasing adiposity. Weight loss interventions aimed at improving lipid profile, blood glucose, and blood pressure may help reduce job-related CVD mortality in American firefighters.

0737 Obstructive Sleep Apnea: A Distinct Physiological Phenotypic Risk Factor in older adults with Cognitive decline and Alzheimer’s disease

0737 Obstructive Sleep Apnea: A Distinct Physiological Phenotypic Risk Factor in older adults with Cognitive decline and Alzheimer’s disease

Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management

ObjectiveThis study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS). DesignSecondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States. SettingCommunity. ParticipantsAmbulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration). InterventionsNot applicable. Main Outcome MeasuresAll participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months. Results155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential. ConclusionsThis study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual’s needs.

FR-10 BIFOCALS AND BLADDER OUTLET OBSTRUCTION: BENJAMIN FRANKLIN AND HIS FASCINATING UROLOGIC MORBIDITIES AND CONTRIBUTIONS TO OUR FIELD

You have accessJournal of UrologyHistory Forum1 Apr 2018FR-10 BIFOCALS AND BLADDER OUTLET OBSTRUCTION: BENJAMIN FRANKLIN AND HIS FASCINATING UROLOGIC MORBIDITIES AND CONTRIBUTIONS TO OUR FIELD Allison Glass and Marc Dall'Era Allison GlassAllison Glass More articles by this author and Marc Dall'EraMarc Dall'Era More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3030AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Benjamin Franklin (1706-1790) is a well renowned 18th century American author, diplomat and scientist. As one the Founding Fathers of the United States, he also made contributions to the study of physics, electricity and medicine. In addition to the study and promotion of smallpox inoculation he was instrumental to the development of bifocal glasses. Benjamin Franklin may also be credited for advancing the field of urology. He suffered from bladder stones and is theorized to have had multiple physiologic risk factors for developing uric acid urolithiasis. We sought to further understand the role Benjamin Franklin played to the field of Urology. METHODS A comprehensive PubMed search was performed. We reviewed articles captures under search words "Benjamin Franklin," "medicine," "stone," and "urology." RESULTS Benjamin Franklin was credited for inventing the flexible urethral catheter. The idea came about after he was contacted by his older brother, who suffered from bladder stones and severe lower urinary tract symptoms. Franklin designed a flexible catheter which had been crafted by a silversmith. Franklin was documented to have history of gout and bladder stones. It is theorized that his urolithiasis was largely related to hyperuricemia. Unfortunately, no pathological specimens from Franklin's stones exist to confirm this theory. He is described as having multiple risk factors for uremia, including genetics, gender, diet, age (Finger and Hagemann, 2008). It is also proposed that psoriasis and exposure to lead may a have contributed to his stone disease. In addition to early American Colony culture, his occupation is also presumed to have resulted in cumulatively significant lead exposure and lead toxicity can compromise the kidney's ability to excrete urate. At the time, treatment for urolithiasis consisted of alkaline medicines including "Blackrie's solvent," a concoction that included soap lye. There is no evidence that Franklin used his own flexible catheter. Franklin's morbidity from gout - and possibly his bladder stones - reportedly may have compromised some his diplomatic obligations. Franklin had such debilitation from bladder stones, that he was reportedly bed-bound and opioid-dependent in the last year of his life. Detailed accounts of Franklin's suffering from his bladder stone are described in his letters to family and friends (Corner and Goodwin, 1953). CONCLUSIONS Benjamin Franklin's place in the history of science and medicine includes unique ties to the field of urology. He himself suffered from severe symptoms secondary to bladder stones. His development of urethral catheter and struggles with stone morbidity no doubt impacted both colonial and modern day urology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1244 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Allison Glass More articles by this author Marc Dall'Era More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial

The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or “booster” sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted.

Towards Bridging Translational Gap in Cardiotoxicity Prediction: an Application of Progressive Cardiac Risk Assessment Strategy in TdP Risk Assessment of Moxifloxacin

Drug-induced cardiac arrhythmia, especially occurrence of torsade de pointes (TdP), has been a leading cause of attrition and post-approval re-labeling and withdrawal of many drugs. TdP is a multifactorial event, reflecting more than just drug-induced cardiac ion channel inhibition and QT interval prolongation. This presents a translational gap in extrapolating pre-clinical and clinical cardiac safety assessment to estimate TdP risk reliably, especially when the drug of interest is used in combination with other QT-prolonging drugs for treatment of diseases such as tuberculosis. A multi-scale mechanistic modeling framework consisting of physiologically based pharmacokinetics (PBPK) simulations of clinically relevant drug exposures combined with Quantitative Systems Toxicology (QST) models of cardiac electro-physiology could bridge this gap. We illustrate this PBPK-QST approach in cardiac risk assessment as exemplified by moxifloxacin, an anti-tuberculosis drug with abundant clinical cardiac safety data. PBPK simulations of moxifloxacin concentrations (systemic circulation and estimated in heart tissue) were linked with in vitro measurements of cardiac ion channel inhibition to predict the magnitude of QT prolongation in healthy individuals. Predictions closely reproduced the clinically observed QT interval prolongation, but no arrhythmia was observed, even at ×10 exposure. However, the same exposure levels in presence of physiological risk factors, e.g., hypokalemia and tachycardia, led to arrhythmic event in simulations, consistent with reported moxifloxacin-related TdP events. Application of a progressive PBPK-QST cardiac risk assessment paradigm starting in early development could guide drug development decisions and later define a clinical “safe space” for post-approval risk management to identify high-risk clinical scenarios.

Incidence of fall related injury in people aged 50 and above and risk factors in 8 provinces in China: a cross-sectional study

Objective: To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological, psychological and social risk factors. Methods: Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China. Two-level hierarchical logistic model was used to identify the related factors for fall-related injury. All the models were stratified by living area (urban/rural). Results: Estimated incidence of fall related injury (road traffic injury was not included) was 3.2%. Ageing and multiple chronic conditions (OR=2.55, 95%CI: 1.41-4.64) was significantly associated with the incidence of fall related injury in urban area. In rural area, depression (OR=4.33, 95% CI: 2.52-7.42) and multiple chronic conditions (OR=2.46, 95%CI: 1.37-4.41) were associated with the incidence of fall related injury. Conclusions: This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China. A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents. Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

HAPT2D: high accuracy of prediction of T2D with a model combining basic and advanced data depending on availability.

Type 2 diabetes arises from the interaction of physiological and lifestyle risk factors. Our objective was to develop a model for predicting the risk of T2D, which could use various amounts of background information. We trained a survival analysis model on 8483 people from three large Finnish and Spanish data sets, to predict the time until incident T2D. All studies included anthropometric data, fasting laboratory values, an oral glucose tolerance test (OGTT) and information on co-morbidities and lifestyle habits. The variables were grouped into three sets reflecting different degrees of information availability. Scenario 1 included background and anthropometric information; Scenario 2 added routine laboratory tests; Scenario 3 also added results from an OGTT. Predictive performance of these models was compared with FINDRISC and Framingham risk scores. The three models predicted T2D risk with an average integrated area under the ROC curve equal to 0.83, 0.87 and 0.90, respectively, compared with 0.80 and 0.75 obtained using the FINDRISC and Framingham risk scores. The results were validated on two independent cohorts. Glucose values and particularly 2-h glucose during OGTT (2h-PG) had highest predictive value. Smoking, marital and professional status, waist circumference, blood pressure, age and gender were also predictive. Our models provide an estimation of patient's risk over time and outweigh FINDRISC and Framingham traditional scores for prediction of T2D risk. Of note, the models developed in Scenarios 1 and 2, only exploited variables easily available at general patient visits.

Mind-Body Therapies for African-American Women at Risk for Cardiometabolic Disease: A Systematic Review.

Background A major determinant in cardiometabolic health is metabolic syndrome (MetS), a cluster of symptoms that portend the development of cardiovascular disease (CVD). As mind-body therapies are thought to help in lowering physiological and environmental CVD risk factors including blood pressure and psychological stress, they may also be beneficial for the primary prevention of CVD. Objectives To synthesize and summarize existing knowledge on the effectiveness of mind-body therapies on MetS outcomes in African-American (AA) women, a US subpopulation at high risk for CVD. Search Methods A systematic search of eight databases was conducted in order to identify published papers addressing the topic. We included trials involving AA adult women, ages 18–64, and we included RCTs that involved multifactorial interventions. Outcomes of interest were MetS, chronic disease, and CVD risk factors (blood pressure, blood lipids, blood glucose, BMI, waist circumference, and mental health domains). Two authors independently selected trials for inclusion, extracted data, and assessed risks of bias. Main Results We identified five trials for inclusion in this review. One study reported outcomes associated with the full MetS symptom cluster. The included trials were small, short term, and at high risk of bias. All interventions lasted at least 6 weeks.

Barriers for the referral to outpatient cardiac rehabilitation: A predictive model including actual and perceived risk factors and perceived control.

Objective:To assess the roles of demographic factors, actual and perceived risk factors, and perceived control in the referral to cardiac rehabilitation (CR) after coronary artery bypass graft (CABG).Methods:In this cross-sectional study, data related to 312 CABG patients in a hospital of the Western part of Iran, gathered through demographics and actual risk factors’ checklist, open single item of perceived heart risk factors, life stressful events scale, and perceived control questionnaire. Data analyzed by binary logistic regression.Results:The results showed that only 8.3% of CABG patients refer to CR. The facilitators of this referral included official employment (P < 0.05), coronary history (P = 0.016), and hyperlipidemia (P = 0.030) but more distance to the CR center (P = 0.042) and perceived physiological risk factor (P = 0.025) are concerned as the barriers for the referral to CR.Conclusion:Providing appropriate awareness about the benefits of CR for patients with regard to their job status, coronary history, and perception about the illness risk factors can be effective in referral to CR. In addition, the presence of CR centers in towns and facilitated achievement to these centers can play a significant role in patients’ participation.

Nutritional status of the geriatric population in the field practice area of a medical college in Rajasthan

Background: Ageing is a physiological process that starts from birth, continues throughout life, and ends with death. Poor nutrition is not a natural concomitant of ageing; older adults are at risk for malnutrition due to physiological, psychological, social, dietary, and environmental risk factors. The objectives of the study were to assess the nutritional status of elderly living in rural India and to study the factors related to nutritional status.Methods: Community-based cross-sectional study was undertaken in the field practice area of Pacific Medical College and Hospital, Udaipur, Rajasthan. Predesigned and pretested questionnaire and nutritional status were assessed using mini nutritional assessment scale for elderly people. Results: Out of the total 152 participants, 2 (1.3%) were having BMI less than 19, 11 (7.2%) were having BMI 19 to less than 21 and 43 (28.3%) were having BMI 21 to less than 23. Out of 152 participants, 30 (41.1%) males and 43 (54.4%) females were at risk of malnutrition. Six (8.2%) males and 5 (6.4%) females were suffering from malnutrition. However, the association of gender and nutritional status of elderly was not found to be statistically significant (p=0.258). Conclusions: Due to the high prevalence of elderly who were malnourished or at risk of malnutrition, a more detailed evaluation, regular follow up &amp; dietary intervention to reverse the situation is required.

Abstract 21108: Early Evidence That the Female Genome Does Matter for Acute Coronary Syndrome Risk

Introduction: Women of all ethnicities have the highest rates of Acute Coronary Syndrome (ACS) misdiagnosis, delayed treatment, and ACS-related near-term mortality. Known physiologic differences and traditional risk factors have failed to fully explain these ACS disparities among women. Our knowledge gap of genomic variation underlying women’s unique ACS phenotypes means that there is no female-derived ACS risk biomarker that reflects female-specific biology and phenotype features. Among 510 women, we previously identified 122 SNPs within 14 genomic regions that significantly predicted ‘survivorship in CAD’ (all-cause mortality among coronary artery disease cases; p&lt;10-5); none of which were significant in males or controls. Given the recent recognition of sex as a biological variable, our purpose was to identify female-specific genomic markers that predict ACS case status. Methods: We performed secondary case-control analysis for 1,382 females (796 ACS cases/586 non-ACS controls) of the Duke Catheterization Genetics (CATHGEN) Study (Illumina Human Infinium 1.0 platform). ACS was defined as having no previous MI history plus either documented unstable angina pain type or incident myocardial infarction. We employed logistic regression models of ACS case status for each SNP separately, assuming additive genetic models, and controlling for age and 3 PCAs of ethnicity. Results: Twenty-three SNPs among 3 biologically relevant candidates ( LPAGT1 , SLC9A9 , &amp; RAP1GAP2 ) significantly predicted women’s ACS (range p=7.43x10 -5 - 0.05) with positive and negative odds ratios observed. LPGAT1 is involved in cardiolipin synthesis; SLC9A9 is involved in endosome recycling; and, RAP1GAP2 regulates secretion of dense granules from platelets at endothelial damage sites. Additionally, 74 SNPs within the 11 novel survivorship with CAD candidates significantly predicted ACS (p&lt;0.05). Conclusions: We demonstrate proof of principal for unique , female-specific genomic effects on ACS case status; and, shared genomic variation with ACS and survivorship in CAD among women. Validation of this work is required. Future research is needed to identify female-derived genomic markers that may uniquely characterize women’s ACS and coronary disease expression.

Study of Metabolic Syndrome and Its Components Among Kurnool District Population of Andhra Pradesh with Different Ethnic Backgrounds

Background: There is a constant increase in the preponderance of cardiovascular diseases in India. The recent scientific evidences have shown that if you do not detect and treat the metabolic syndrome patients at an early stage, it may proceed to cardiovascular disease. A scientific data on pattern of metabolic syndrome components of a population is very essential to formulate the preventive and treatment modalities among them. Aim: To explore the prevalence of metabolic syndrome and its components among Kurnool district population of Andhra Pradesh with different ethnic background. Method: A total of 1032 (344 subjects in each group) participants of 20-60 years of age group were analyzed for MetS. A modified NCEP ATP III criterion was applied for this. From each group 20 subjects were analyzed for fasting serum insulin and HOMA-IR randomly. Results: Overall prevalence of metabolic syndrome was found to 31.97%. It was almost equally prevalent among men (32.82%) and women (30.87%). Urban population (42.15%) were found to be highly inflicted by metabolic syndrome than rural (31.97%) and tribal (21.80%). Decreased HDL (78.87%) followed by increased waist circumference (57.84%) and hypertriglyceridemia (31.78%) were found to be the preceding risk factors of Mets in all the groups. The lipid estimates were not in correlation with insulin resistance (by HOMA IR) in rural population. Tribal women were found to be having a slightly higher mean waist circumference (86.45cm) compared to rural women (85.87cm). The behavioural cardiovascular risk factors like smoking alcohol consumption decreased circadian physical activity were high in rural and tribal population compared to urban population. Whereas other physiological cardiovascular risk factors like family history of hypertension and diabetes of rural population were in concordance to urban population. Conclusion: Metabolic syndrome prevalence is very high in Kurnool district population. Mets components are highly prevalent among the individuals with low WC (Waist Circumference) and BMI (Body Mass Index). This warrants the need to implement preventive strategies for Mets among the population of Kurnool district. The future projects has to be formulated with an aim to find out the genetic factors behind this scenario.

Socio-economic trajectories and cardiovascular disease mortality in older people: the English Longitudinal Study of Ageing.

BackgroundSocio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain.ObjectivesWe assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults.MethodsParticipants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002–03. Comprising four indicators of socio-economic status (father’s social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional ‘change-in-estimate method’ and alternative approaches such as counterfactual mediation modelling could not be applied in this context.ResultsDuring the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest.ConclusionsIn a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention.

Type 2 diabetes and cognitive dysfunction in minorities: a review of the literature

ABSTRACTObjectives: The purpose of this review was to summarize the current status of knowledge regarding cognitive dysfunction and diabetes in minorities. Literature on the interaction of cognitive dysfunction and diabetes was analyzed to (a) examine the number and characteristics of studies in minority populations; (b) identify tests used to assess cognitive function in diabetes; (c) consider the impact of diabetes on cognitive function; and (d) assess the moderators of the association between diabetes and cognitive function.Design: A literature review and thematic analysis was conducted. Studies were mapped to describe their design, target population, instruments used, and the physiologic, psychosocial, and socioeconomic findings related to cognitive function and diabetes. Twelve studies met the inclusion criteria.Results: Hispanics were studied more than any other ethnic group. Rates and degree of cognitive dysfunction were more prevalent in minorities than non-Hispanic whites. Overall, 28 different tests were administered to evaluate cognitive function. There was some variation among findings regarding the relationship of cognitive function and diabetes. Risk for cognitive decline was associated with the diagnosis of diabetes alone, regardless of whether the diabetes was treated or untreated. Higher rates of discrimination were associated with greater cognitive declineConclusion: Given the context of minority health, there is a potential for higher negative health impact due to the increased prevalence of diabetes and cognitive dysfunction and other related health disparities. Reduction of physiological risk factors for diabetes, consistency in assessment, as well as elimination of structural barriers such as access to care should be helpful in decreasing the incidence of both diabetes and cognitive decline. More research is needed to determine whether the observed differences are modifiable and to identify factors involved in the interaction of diabetes and cognitive decline—not only physiological factors, but factors related to socioeconomic status and quality of life.

Training community health workers to screen for cardiovascular disease risk in the community: experiences from Cape Town, South Africa.

SummaryIntroductionThis article describes a training process to equip community health workers (CHWs) with knowledge and skills to identify individuals at high risk for cardiovascular disease (CVD) in a township in Cape Town.Methods:CHWs were employed by a non-governmental organisation (NGO) primarily focusing on non-communicable diseases (NCDs). They were trained in the theory of CVD, including physiological changes and related risk factors and in obtaining anthropometric and blood pressure measurements. Pre- and post-training tests assessed learning needs and the effectiveness of imparting knowledge about CVD, respectively.Results:Training increased knowledge about CVD risk factors. CHWs were able to screen and identify those at risk for CVD and refer them to health professionals for validation of scores. The initial one-week training was too short, given the amount of information covered. Some CHWs had difficulty with English as the primary instruction medium and as the only language in which tests were offered.Conclusion:Although CHWs could be trained to screen for CVD risk, increased training time was required to impart the knowledge. The language used during training and testing presented challenges for those trainees whose dominant, spoken language was not English.