Publications by authors named "Douglas D Schocken"

32 Publications

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort.

J Am Geriatr Soc 2019 01 9;67(1):43-49. Epub 2018 Oct 9.

Department of Public Health Sciences, School of Medicine Wake Forest University, Winston-Salem, North Carolina.

Objectives: To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs).

Design: Cohort SETTING: Cardiovascular Health Study.

Participants: Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6).

Measurements: The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status.

Results: Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91-1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25-2.13, p < .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82-1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02-1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI.

Conclusion: Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43-49, 2019.
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http://dx.doi.org/10.1111/jgs.15604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346740PMC
January 2019

When Complementary and Alternative Medicine Meets Heart Failure-a Modest Proposal.

J Card Fail 2018 03 1;24(3):202-203. Epub 2018 Feb 1.

Duke University School of Medicine, Durham, NC. Electronic address:

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http://dx.doi.org/10.1016/j.cardfail.2018.01.006DOI Listing
March 2018

The 4th Report of the Working Group on ECG diagnosis of Left Ventricular Hypertrophy.

J Electrocardiol 2017 Jan - Feb;50(1):11-15. Epub 2016 Nov 10.

Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden; Nicollier-Schlegel SARL, Trélex, Switzerland.

The 4th Report provides a brief review of publications focused on the electrocardiographic diagnosis of left ventricular hypertrophy published during the period of 2010 to 2016 by the members of the Working Group on ECG diagnosis of Left Ventricular Hypertrophy. The Working Group recommended that ECG research and clinical attention be redirected from the estimation of LVM to the identification of electrical remodeling, to better understanding the sequence of events connecting electrical remodeling to outcomes. The need for a re-definition of terms and for a new paradigm is also stressed.
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http://dx.doi.org/10.1016/j.jelectrocard.2016.11.003DOI Listing
November 2017

Prediabetes and the association with unrecognized myocardial infarction in the multi-ethnic study of atherosclerosis.

Am Heart J 2015 Nov 8;170(5):923-8. Epub 2015 Aug 8.

Public Health Sciences at the Wake Forest University School of Medicine, Winston-Salem, NC.

Background: With one-quarter of initial myocardial infarctions (MI) being unrecognized MI (UMI), recognition is critical to minimize further cardiovascular risk. Diabetes mellitus is an established risk factor for UMI. If impaired fasting glucose (IFG) also increased the risk for UMI, it would represent a significant public health challenge due to the rapid worldwide increase in IFG prevalence. We compared participants with IFG to those with normal fasting glucose (NFG) to determine if IFG was associated with UMIs.

Methods: We performed cross-sectional analyses from the MESA, a population-based cohort study. There were 6,814 participants recruited during July 2000 to September 2002 from the general community at 6 field sites. After excluding those with diabetes mellitus or missing variables, 5,885 participants were included. At baseline, there were 4,955 participants with NFG and 930 participants with IFG. The main outcome was an UMI defined by the presence of pathological Q waves or minor Q waves with ST-T abnormalities on initial 12-lead electrocardiogram. Logistic regression was used to generate crude ORs and adjust for covariates.

Results: There was a higher prevalence of UMI in those with IFG compared with those with NFG [3.5% (n = 72) vs 1.4% (n = 30)]. After adjustment for multiple risk factors, there was a higher odds of an UMI among those with IFG compared with those with NFG [OR: 1.60 (95% CI: 1.0-2.5); P = .048].

Conclusions: Impaired fasting glucose is associated with unrecognized myocardial infarctions in a multi-ethnic population free of baseline cardiovascular disease.
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http://dx.doi.org/10.1016/j.ahj.2015.08.003DOI Listing
November 2015

Emerging risk factors as markers for carotid intima media thickness scores.

J Am Coll Nutr 2015 9;34(2):100-7. Epub 2015 Mar 9.

a Masley Optimal Health Center , St. Petersburg , Florida.

Aims: Cardiovascular disease (CVD) remains the number one cause of mortality in the Western world. This study aims to determine which lifestyle factors are associated with mean carotid intima media thickness (IMT), a safe and reliable predictor of future CVD risk.

Methods And Results: A prospective cross-sectional analysis of 592 subjects. Measures were made of body composition, anthropometric measures, fitness, diet (measured with a 3-day food diary), laboratory results, and mean carotid IMT. Multivariate analyses show that higher mean IMT values are associated with increasing age (p < 0.0001), male gender (p = 0.0002), higher systolic blood pressure (BP; p = 0.0008), higher body mass index (BMI; p = 0.0005), and lower intake of zinc (p = 0.0001). Bivariate analyses controlling for age and gender, with and without statin use, showed that higher mean IMT scores were statistically associated with higher diastolic BP (p = 0.007), higher total cholesterol/high-density lipoprotein (HDL) ratio (p < 0.0001), higher triglyceride/HDL ratio (p = 0.0001), lower aerobic capacity measures (p = 0.0007), higher body fat percentage and waist circumference (p < 0.0001), higher fasting glucose level (p = 0.028), and lower intake of magnesium (p = 0.019), fish (p = 0.007), and fiber (p = 0.02). Other factors that were not associated with mean IMT include total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP); intake of saturated fat, potassium, calcium, sodium, or vitamin K; percentage of calories from protein, fat, or carbohydrate; measures of strength (assessed with push-up and sit-up testing); and reported exercise.

Conclusions: Aerobic fitness and dietary intake of fiber, fish, magnesium, and zinc are inversely associated with carotid IMT scores. Of the traditional CVD risk factors, only systolic BP, fasting glucose, body composition, and total cholesterol/HDL ratio have a direct relationship with mean carotid IMT.
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http://dx.doi.org/10.1080/07315724.2014.916238DOI Listing
January 2016

The 1st symposium on ECG changes in left or right ventricular hypertension or hypertrophy in conditions of pressure overload.

J Electrocardiol 2014 Sep-Oct;47(5):589-92. Epub 2014 Jul 3.

Duke Clinical Research Institute, Durham, NC, USA.

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http://dx.doi.org/10.1016/j.jelectrocard.2014.07.004DOI Listing
May 2015

Electrocardiographic left ventricular strain pattern: everything old is new again.

J Electrocardiol 2014 Sep-Oct;47(5):595-8. Epub 2014 Jun 13.

Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.

Electrocardiographic left ventricular hypertrophy (LVH) has many faces with countless features. Beyond the classic measures of LVH, including QRS voltage and duration, the left ventricular (LV) strain pattern is an element whereby characteristic R-ST depression is followed by a concave ST segment that ends in an asymmetrically inverted T wave. The LV strain pattern generally appears in states of increased systemic blood pressure and must be differentiated from similar but not identical ST-T waves indicating ischemia. The LV strain pattern has been found in population studies to be associated with poor prognosis and increased risk of adverse cardiovascular outcomes. Regression of LV strain pattern parallels decline in systemic BP during clinical trials of anti-hypertensive therapies but does not indicate or serve as a surrogate for decrease in LV mass. Newer techniques in data collection and processing may allow the process of strain to be studied in more detail to determine the ways in which electrical remodeling of the left ventricle as characterized by LVH with 'repolarization abnormalities' indicates how CV risk might be managed by using LV strain pattern as an electrocardiographic biomarker.
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http://dx.doi.org/10.1016/j.jelectrocard.2014.06.005DOI Listing
May 2015

Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study.

J Am Coll Cardiol 2012 Sep 1;60(12):1053-63. Epub 2012 Aug 1.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.

Objectives: The aim of this study was to assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease.

Background: Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well defined.

Methods: One hundred one outpatients with coronary heart disease and elevated depressive symptoms underwent assessment of depression, including a psychiatric interview and the Hamilton Rating Scale for Depression. Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability, endothelial function, baroreflex sensitivity, inflammation, and platelet function.

Results: After 16 weeks, all groups showed improvement on Hamilton Rating Scale for Depression scores. Participants in both the aerobic exercise (mean -7.5; 95% confidence interval: -9.8 to -5.0) and sertraline (mean -6.1; 95% confidence interval: -8.4 to -3.9) groups achieved larger reductions in depressive symptoms compared with those receiving placebo (mean -4.5; 95% confidence interval: -7.6 to -1.5; p = 0.034); exercise and sertraline were equally effective at reducing depressive symptoms (p = 0.607). Exercise and medication tended to result in greater improvements in heart rate variability compared with placebo (p = 0.052); exercise tended to result in greater improvements in heart rate variability compared with sertraline (p = 0.093).

Conclusions: Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in patients with coronary heart disease. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as on quality of life. (Exercise to Treat Depression in Individuals With Coronary Heart Disease; NCT00302068).
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http://dx.doi.org/10.1016/j.jacc.2012.04.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498445PMC
September 2012

The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial.

Int J Nurs Stud 2011 Jan 7;48(1):3-12. Epub 2010 Jul 7.

University of South Florida, FL 33612, United States.

Background: Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence.

Objective: To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD.

Methods: A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time.

Results: Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446)=4.42, p=.013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446)=2.00, p=.137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223)=50.34, p<.001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223)=19.25, p<.001).

Conclusion: This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.
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http://dx.doi.org/10.1016/j.ijnurstu.2010.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108994PMC
January 2011

Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry.

Am Heart J 2009 May;157(5):926-32

Department of Medicine and Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC 27514, USA.

Background: Although a potentially important pathophysiologic factor in heart failure, the prevalence and predictors of anemia have not been well studied in unselected patients with heart failure.

Methods: The Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry prospectively studied the prevalence of anemia and the relationship of hemoglobin to health-related quality of life and outcomes among patients with heart failure. A random selection algorithm was used to reduce bias during enrollment of patients seen in specialty clinics or clinics of community cardiologists with experience in heart failure. In this initial report, data on prevalence and correlates of anemia were analyzed in 1,076 of the 1,082 registry patients who had clinical characteristics and hemoglobin determined by finger-stick at baseline.

Results: Overall (n = 1,082), the registry patients were 41% female and 73% white with a mean age (+/-SD) of 64 +/- 14 years (68 +/- 13 years in community and 57 +/- 14 years in specialty sites, P < .001). Among the 1,076 patients in the prevalence analysis, mean hemoglobin was 13.3 +/- 2.1 g/dL (median 13.2 g/dL); and anemia (defined by World Health Organization criteria) was present in 34%. Age identified patients at risk for anemia, with 40% of patients >70 years affected.

Conclusions: Initial results from the STAMINA-HFP Registry suggest that anemia is a common comorbidity in unselected outpatients with heart failure. Given the strong association of anemia with adverse outcomes in heart failure, this study supports further investigation concerning the importance of anemia as a therapeutic target in this condition.
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http://dx.doi.org/10.1016/j.ahj.2009.01.012DOI Listing
May 2009

Examining the challenges of recruiting women into a cardiac rehabilitation clinical trial.

J Cardiopulm Rehabil Prev 2009 Jan-Feb;29(1):13-21; quiz 22-3

College of Nursing, University of South Florida, Tampa, FL 33612, USA.

Purpose: To examine the challenges of recruiting women for a 5-year cardiac rehabilitation randomized clinical trial; the aims of the study were to describe the range of recruitment sources, examine the myriad of factors contributing to ineligibility and nonparticipation of women during protocol screening, and discuss the challenges of enrolling women in the trial.

Methods: The Women's-Only Phase II Cardiac Rehabilitation program used an experimental design with 2 treatment groups. Eligible participants included women who were (1) diagnosed with a myocardial infarction or stable angina or had undergone coronary revascularization within the last 12 months; (2) able to read, write, and speak English; and (3) older than 21 years. Responses to multiple recruitment strategies including automatic hospital referrals, physician office referrals, mass mailings, media advertisements, and community outreach are described. Reasons for ineligibility and nonparticipation in the trial are explored.

Results: Automatic hospital order was the largest source of referral (n = 1,367, 81%) accounting for the highest enrollment rate of women (n = 184, 73%). The barriers to enrollment into the cardiac rehabilitation clinical trial included patient-oriented, provider-oriented, and programmatic factors. Of the referral sources, 52% were screened ineligible for provider-oriented reasons, 31% were ineligible due to patient-oriented factors, and 17.4% were linked to the study protocol. Study nonparticipation of those eligible (73.8%) was largely associated with patient-oriented factors (65.2%), with far less due to provider-related factors (4%) or study-related factors (3.4%).

Conclusion: Standing hospital orders facilitated enrollment to the cardiac rehabilitation clinical trial, yet women failed to participate predominantly due to significant patient-oriented biopsychosocial barriers.
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http://dx.doi.org/10.1097/HCR.0b013e31819276cbDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699627PMC
March 2009

Racial/ethnic disparities in mortality related to congenital heart defects among children and adults in the United States.

Ethn Dis 2008 ;18(4):442-9

Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.

Background: Congenital heart defects (CHD) are the most common birth defect and are a major cause of childhood illness and death. Recent progress in management of persons with CHD may have decreased CHD-related mortality.

Methods: Year 2000 US death records were used to determine CHD-related mortality by age, sex, and race/ethnicity in children and adults. CHD-related mortality was defined as all deaths with any mention of CHD on the death certificate. Age-, sex-, and racial/ethnic-specific population counts were obtained from the 2000 US Census and used as denominators in mortality rates.

Results: In 2000 there were 5441 (.23%) CHD-related deaths and CHDs were mentioned 6121 times as the underlying or contributing cause of death. In 68.4% of CHD-related deaths, CHD was the underlying cause of death. Non-Hispanic Black males had greater risk of CHD-related death than did non-Hispanic White males (RR 1.25, 95% CI 1.08-1.45). Both Hispanic males and females had lower rates of CHD-related deaths than did non-Hispanic Whites (RR .72, 95% CI .60-.85; RR .52, 95% CI .42-.65, respectively). "Unspecified congenital malformation of the heart" was the most common cause of death overall; however, "malformation of the coronary vessels" was most often a cause of death for non-Hispanic Blacks and children aged 10-19 years.

Conclusions: Racial/ethnic differences in CHD-related mortality exist in the United States. Management of CHD, access to adequate care, and misclassification in cause of death reporting on death records may explain the observed differences.
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February 2009

American Society for Preventive Cardiology.

Prev Cardiol 2008 ;11(2):127-8

American Society of Preventive Cardiology.

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http://dx.doi.org/10.1111/j.1751-7141.2008.07769.xDOI Listing
June 2008

Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group.

Circulation 2008 May 7;117(19):2544-65. Epub 2008 Apr 7.

University of South Florida, USA.

The increase in heart failure (HF) rates throughout the developed and developing regions of the world poses enormous challenges for caregivers, researchers, and policymakers. Therefore, prevention of this global scourge deserves high priority. Identifying and preventing the well-recognized illnesses that lead to HF, including hypertension and coronary heart disease, should be paramount among the approaches to prevent HF. Aggressive implementation of evidence-based management of risk factors for coronary heart disease should be at the core of HF prevention strategies. Questions currently in need of attention include how to identify and treat patients with asymptomatic left ventricular systolic dysfunction (Stage B HF) and how to prevent its development. The relationship of chronic kidney disease to HF and control of chronic kidney disease in prevention of HF need further investigation. Currently, we have limited understanding of the pathophysiological basis of HF in patients with preserved left ventricular systolic function and management techniques to prevent it. New developments in the field of biomarker identification have opened possibilities for the early detection of individuals at risk for developing HF (Stage A HF). Patient groups meriting special interest include the elderly, women, and ethnic/racial minorities. Future research ought to focus on obtaining a much better knowledge of genetics and HF, especially both genetic risk factors for development of HF and genetic markers as tools to guide prevention. Lastly, a national awareness campaign should be created and implemented to increase public awareness of HF and the importance of its prevention. Heightened public awareness will provide a platform for advocacy to create national research programs and healthcare policies dedicated to the prevention of HF.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.107.188965DOI Listing
May 2008

Adverse baseline physiological and psychosocial profiles of women enrolled in a cardiac rehabilitation clinical trial.

J Cardiopulm Rehabil Prev 2008 Jan-Feb;28(1):52-60

College of Nursing, University of South Florida, Tampa, FL 33612, USA.

Purpose: Coronary heart disease (CHD) remains the leading cause of death in women. Despite positive outcomes associated with cardiac rehabilitation (CR), investigations of women are sparse. This article presents the baseline physiological and psychosocial profiles of 182 women in the Women's-Only Cardiac Rehabilitation study.

Method: Women were randomized to a women's-only motivational interviewing or traditional CR group. Physiological measures included lipid profiles, body mass index, functional capacity, and anthropomorphic measures. Psychosocial measures included optimism, hope, social support, anxiety, depression, quality of life, and health perceptions. The median age was used to split the sample to examine data on 92 younger (< or = 64 years) and 90 older (>64 years) women.

Results: With a mean age of 63 years, 66.5% were white, 47% were retired, and 54% were married. Most women were physically inactive (83%), hypertensive (76%), and overweight (56%). Most women (71.4%) met the criteria for metabolic syndrome. Younger women demonstrated significantly worse psychosocial profiles than older women. More of the younger women (64%) had depressive symptoms than older women (37%). Younger women demonstrated a mean Center for Epidemiological Studies Depression Scale score of 20.8 +/- 12.4, whereas older women had a substantially lower mean score of 14.9 +/- 9.5 (P < .001). Younger participants also reported significantly more anxiety than older participants (38.8 +/- 13.4 vs 32.8 +/- 10.6, P < .001).

Conclusion: Younger women enrolled in a CR clinical trial had adverse baseline risk factor profiles placing them at high risk for disease progression.
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http://dx.doi.org/10.1097/01.HCR.0000311510.16226.6eDOI Listing
March 2008

American society for preventive cardiology.

Prev Cardiol 2007 ;10(4):238-9

American Society for Preventive Cardiology, USA.

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http://dx.doi.org/10.1111/j.1520-037x.2007.06072.xDOI Listing
December 2007

Diabetes-induced bradycardia is an intrinsic metabolic defect reversed by carnitine.

Metabolism 2007 Aug;56(8):1118-23

Julia Parrish Diabetes Research Institute, University of South Florida College of Medicine, Tampa, FL 33612-4742, USA.

Rats with streptozotocin-induced diabetes (STZ-D) have reduced serum carnitine levels and bradycardia. Heart rates (HRs) of 24nondiabetic rats (NRs) and 24 STZ-D rats were compared. L-carnitine (C) was added to the drinking water of rats (12 STZ-D+C) to raise their serum carnitine level. The intrinsic HR for each animal was determined after parasympathetic and sympathetic blockade. The HRs of STZ-D rats (278+/-15 beats per minute) were less than those of NRs (348+/-8 beats per minute) (P<.01). STZ-D rats had low serum carnitine compared with control and STZ-D+C rats. The difference in HR of STZ-D rats and NRs continued after blockade, indicating that the bradycardia ofdiabetes is intrinsic to the heart. The metabolic milieu reflected in the rats' urinary organic acid profiles differed between the control and STZ-D rats. The HR of STZ-D+C rats (326+/-5 beats per minute) did not differ from those of NRs. Increasing either the insulin dose or the serum free carnitine reduced urinary organic acids, but normal HRs were associated only with elevated serum carnitine levels. When glucose is compromised as a myocardial energy source (diabetes mellitus), we propose that elevated levels of serum carnitine may increase myocardial fatty acid metabolism sufficiently to correct the bradycardia of STZ-D rats.
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http://dx.doi.org/10.1016/j.metabol.2007.04.005DOI Listing
August 2007

The girth of a nation--a call to arms...and legs.

Prev Cardiol 2006 ;9(4):241-2

American Society for Preventive Cardiology.

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http://dx.doi.org/10.1111/j.1520-037x.2006.05000.xDOI Listing
April 2007

Cardiac tamponade complicating trimodal therapy for malignant mesothelioma.

Heart Lung 2006 Sep-Oct;35(5):355-7

Division of Cardiovascular Disease, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida, USA.

Trimodal therapy, which includes extrapleural pneumonectomy as the cytoreductive procedure followed by combination chemoradiotherapy, is becoming the standard of care in the treatment of malignant mesothelioma. We report here a case of hypotension secondary to tension hydrothorax in which echocardiography and hemodynamic monitoring demonstrated evidence of tamponade physiology. Thoracentesis was lifesaving.
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http://dx.doi.org/10.1016/j.hrtlng.2005.10.006DOI Listing
January 2007

The past as prologue.

Prev Cardiol 2006 ;9(3):183-4

American Society for Preventive Cardiology, USA.

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http://dx.doi.org/10.1111/j.1520-037x.2006.04999.xDOI Listing
October 2006

Cardio-protective effects of carnitine in streptozotocin-induced diabetic rats.

Cardiovasc Diabetol 2006 Jan 19;5. Epub 2006 Jan 19.

The Department of Pediatrics, University of South Florida, College of Medicine, Tampa, FL 33612, USA.

Background: Streptozotocin-induced diabetes (STZ-D) in rats has been associated with carnitine deficiency, bradycardia and left ventricular enlargement.

Aim: The purpose of this study was to determine whether oral carnitine supplementation would normalize carnitine levels and cardiac function in STZ-D rats.

Methods: Wistar rats (48) were made hyperglycemic by STZ at 26 weeks of age. Same age normal Wistar rats (24) were used for comparison. Echocardiograms were performed at baseline 2, 6, 10, and 18 weeks after STZ administration in all animals. HbA1c, serum carnitine and free fatty acids (FFA) were measured at the same times. Since STZ-D rats become carnitine deficient, 15 STZ-D rats received supplemental oral carnitine for 16 weeks.

Results: The heart rates for the STZ-D rats (290 +/- 19 bpm) were less than control rats (324 +/- 20 bpm) (p < 0.05). After 4 weeks of oral carnitine supplementation, the serum carnitine and heart rates of the STZ-D rats returned to normal. Dobutamine stress increased the heart rates of all study animals, but the increase in STZ-D rats (141 +/- 8 bpm) was greater than controls (79 +/- 8 bpm) (p < 0.05). The heart rates of STZ-D rats given oral carnitine, however, were no different than controls (94 +/- 9 bpm). The left ventricular mass/body weight ratio (LVM/BW) in the diabetic animals (2.7 +/- 0.5) was greater than control animals (2.2 +/- 0.3) (p < 0.05) after 18 weeks of diabetes. In contrast, the LVM/BW (2.3 +/- .2) of the STZ-D animals receiving supplemental carnitine was the same as the control animals at 18 weeks.

Conclusion: Thus, supplemental oral carnitine in STZ-D rats normalized serum carnitine, heart rate regulation and left ventricular size. These findings suggest a metabolic mechanism for the cardiac dysfunction noted in this diabetic animal model.
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http://dx.doi.org/10.1186/1475-2840-5-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1363717PMC
January 2006

Combined treatment with vessel dilator and kaliuretic hormone in persons with congestive heart failure.

Exp Biol Med (Maywood) 2004 Jun;229(6):521-7

U.S.F. Cardiac Hormone Center, Department of Medicine, University of South Florida Health Sciences Center, and Medicine and Pharmacy Services, James A. Haley Veterans Medical Center, Tampa, Florida 33612, USA.

Vessel dilator and kaliuretic hormone, two cardiovascular peptide hormones, enhance urine flow 2- to 13-fold and 4-fold, respectively, in persons with class III New York Heart Association congestive heart failure (CHF). The natriuresis and diuresis secondary to vessel dilator and kaliuretic hormone are not blunted as are atrial natriuretic peptide and brain natriuretic peptide effects in persons with CHF compared with healthy individuals. The present investigation determined if the two peptide hormones that do not have blunted effects in persons with CHF may have added beneficial effects when given simultaneously to individuals with class III CHF. Together with each at 100 ng/kg of body weight per minute, vessel dilator and kaliuretic hormone increased urine flow rate 3.5-fold (P < 0.05) compared with their 60-min baseline and control CHF subjects' urine flow rates. Combined, they enhanced the excretion rate of sodium a maximum of 3.6-fold (P < 0.05) with 2.5- and 2-fold enhancement 2 and 3 hrs after infusion. These data indicate that vessel dilator and kaliuretic hormone have diuretic and natriuretic effects when used in combination, but these effects are not additive over their individual effects in persons with CHF.
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http://dx.doi.org/10.1177/153537020422900610DOI Listing
June 2004

Four cardiac hormones increase circulating concentrations of luteinizing hormone and testosterone.

Endocrine 2002 Mar;17(2):145-50

University of South Florida Cardiac Hormone Center, Department of Biochemistry, James A. Haley Veterans Medical Center, Tampa 33612, USA.

This study was designed to determine whether four peptide hormones consisting of amino acids 1-30-long-acting natriuretic hormone (LANH), 31-67 (vessel dilator), 79-98 (kaliuretic hormone), and 99-126 (atrial natriuretic hormone [ANH])-of the 126 amino acid atrial natriuretic prohormone increase the circulating concentration of testosterone in healthy humans (n = 30). Vessel dilator, kaliuretic hormone, LANH, and ANH increased the circulating concentration of testosterone 3.8, 2.6, 3.9, and 3.4-fold, respectively (p < 0.01 for each), when infused at 100 ng/(kg of body wt . min) for 60 min. The increases in testosterone lasted 2.5-3 h after cessation of the respective atrial natriuretic peptides' infusions. ANH, vessel dilator, LANH, and kaliuretic hormone increased luteinizing hormone (LH) 3-to 8.4-fold (p < 0.001) during infusion, with the maximal increase in LH being 6.7- to 11.7-fold (p < 0.001) secondary to these cardiac hormones. Vessel dilator and kaliuretic hormone increased LH before increasing testosterone in a sequential fashion. These data suggest that four peptide hormones-ANH, LANH, vessel dilator, and kaliuretic hormone-increase the circulating con-centrations of LH and testosterone in humans.
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http://dx.doi.org/10.1385/ENDO:17:2:145DOI Listing
March 2002