Publications by authors named "Effoe Valery"

43 Publications

Trends, Predictors and Outcomes of Ischemic Stroke Among Patients Hospitalized with Takotsubo Cardiomyopathy.

J Stroke Cerebrovasc Dis 2021 Jul 28;30(10):106005. Epub 2021 Jul 28.

Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States. Electronic address:

Objectives: This study assessed the temporal trends in the incidence of ischemic stroke among patients hospitalized with takotsubo cardiomyopathy (TCM) stratified by the subtypes of ischemic stroke (cardioembolic versus thrombotic).Predictors of each stroke subtype, the association with atrial fibrillation (AF), the occurrence of ventricular fibrillation/ventricular tachycardia (VF/VT),cardiogenic shock (CS), in-hospital mortality, length of stay (LOS), and total healthcare cost were also assessed.

Background: Ischemic stroke in TCM is thought to be primarily cardioembolic from left ventricular mural thromboembolism. limited data are available on the incidence of thrombotic ischemic stroke in TCM.

Materials And Methods: We identified 27,970 patients hospitalized with the primary diagnosis of TCM from the 2008 to 2017 National Inpatient Sample, of which 751 (3%) developed ischemic stroke. Of those with ischemic stroke, 571 (76%) had thrombotic stroke while 180 (24%) had cardioembolic stroke. Cochrane armitage test was used to assess the incidence of thrombotic and cardioembolic strokes and multivariate regression was used to identify risk factors associated with each stroke subtype. We compared the incidence of AF, VF/VT, CS, LOS, in-hospital mortality and total cost between hospitalized patients with TCM alone to those with cardioembolic and thrombotic strokes.

Results: From 2008 - 2017, the incidence of thrombotic stroke (4.7%-9.5% (p< 0.0001) increased while it was unchanged for cardioembolic stroke (0.5%-0.7% P=0.5). In the multivariate regression, peripheral artery disease, prior history of stroke, and hyperlipidemia were significantly associated with thrombotic stroke, while CS, AF, and Asian race (compared to White race) were associated with cardioembolic stroke. Both cardioembolic and thrombotic strokes were associated with higher odds of IHM, AF, CS, longer LOS and increased cost. Trends in in-hospital mortality and the utilization of thrombolysis, cerebral angiography, and mechanical thrombectomy among patients with TCM and ischemic stroke were unchanged from 2008 to 2017.

Conclusion: Among patients with TCM and ischemic stroke, thrombotic stroke was more common compared to cardioembolic stroke. Ischemic stroke was associated with poorer outcomes, including higher in-hospital mortality and increased healthcare resource utilization in TCM.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106005DOI Listing
July 2021

Intravascular ultrasound-guided catheter-based aspiration thrombectomy in patients with acute submassive pulmonary embolism: A case series.

Cardiovasc Revasc Med 2021 May 19. Epub 2021 May 19.

Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States of America. Electronic address:

Contrast pulmonary angiography by hand injection or power injection is widely used during catheter-based therapies for acute submassive and massive pulmonary embolism (PE). Particularly, in patients with pre-existing chronic kidney disease, this approach may present a prognostic challenge owing to a double-contrast load, initially during computed tomographic pulmonary angiography (CTPA), and during percutaneous treatment. Intravascular ultrasound (IVUS) has been used as an adjunctive imaging modality in the percutaneous treatment of chronic thromboembolic pulmonary hypertension, and in coronary and peripheral vascular interventions. We report a series of cases illustrating the use of IVUS in the management of acute PE. All five patients presented with an acute submassive PE with evidence of right ventricular (RV) strain (RV/LV ratio ≥ 0.90). Body mass index and B-type natriuretic peptide ranged from 18 to 47 kgm/m and 56-932 pg/mL (ref. ≤ 78), respectively. Three of the five patients had renal impairment prior to the procedure (acute kidney injury, AKI, and chronic kidney injury, CKD). Post-catheter-directed pulmonary embolectomy there was a modest reduction in mean pulmonary artery pressure in all five patients (range: -4 mmHg to -9 mmHg). The first case serves as a proof of concept of IVUS use in acute PE. This case series demonstrates that an IVUS-only approach in the catheter-directed management of acute submassive PE is feasible and may be of particular importance in patients with pre-existing renal dysfunction.
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http://dx.doi.org/10.1016/j.carrev.2021.05.016DOI Listing
May 2021

Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection.

Am J Cardiovasc Dis 2021 15;11(2):212-221. Epub 2021 Apr 15.

Division of Cardiovascular Disease, Morehouse School of Medicine Atlanta, GA 30310, USA.

Background: The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients.

Methods: We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events.

Results: Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P<0.0001). The presence of AKI was associated with increased odds of ICU stay, mechanical ventilation, and acute respiratory distress syndrome (ARDS).

Conclusion: pCVD and AKI were associated with higher risk of in-hospital cardiac events, and AKI was associated with a higher risk of in-hospital mortality in blacks.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166582PMC
April 2021

Incidence and Severity of Depression Among Recovered African Americans with COVID-19-Associated Respiratory Failure.

J Racial Ethn Health Disparities 2021 Apr 6. Epub 2021 Apr 6.

Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.

Background: Coronavirus disease (COVID-19) disproportionately affects African Americans, and they tend to experience more severe course and adverse outcomes. Using a simple and validated instrument of depression screening, we evaluated the incidence and severity of major depression among African American patients within 90 days of recovery from severe COVID-19-associated respiratory failure.

Methods: African American patients hospitalized and treated with invasive mechanical ventilation for COVID-19-associated respiratory failure in the intensive care unit (ICU) of Grady Memorial Hospital, Atlanta, between April 1, 2020, and June 30, 2020, were screened for depression within 90 days of hospital discharge using the validated patient health questionnaires (PHQ-2) and PHQ-9.

Results: A total of 73 patients completed the questionnaire. The median age was 52.5 years [IQR 44-65] and 65% were males. The most common comorbidities were hypertension (66%) and diabetes mellitus (51%). Forty-four percent of the patients had a diagnosis of major depressive disorder (MDD) based on their PHQ-9 questionnaire responses. The incidence of MDD was higher among females (69%, n=18/26) compared to males (29%, n=14/47), in patients > 75 years (66%) and those with multiple comorbidities (45%). Eighteen percent of the patients had moderate depression, while 15% and 22% had moderately severe and severe depression, respectively. Only 26% (n=7/27) of eligible patients were receiving treatment for depression at the time of this survey.

Conclusion: The incidence of depression in a cohort of African American patients without prior psychiatric conditions who recovered from severe COVID-19 infection was 44%. More than 70% of these patients were not receiving treatment for depression.
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http://dx.doi.org/10.1007/s40615-021-01034-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023522PMC
April 2021

Trends, Associations, and Impact of Atrial Fibrillation in Patients With Light-chain Cardiac Amyloidosis.

Crit Pathw Cardiol 2021 Sep;20(3):168-172

Department of Medicine, Morehouse School of Medicine, Atlanta, GA.

Background: In this study, we investigated the temporal trends in the prevalence and prognostic implication of atrial fibrillation (AF) in patient with light-chain cardiac amyloidosis (AL-CA).

Methods: We identified 3030 patients with AL-CA from the 2015 to 2017 National Inpatient Sample, of which 1577 (52%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF by subtype from 2015 to 2017. We compared inhospital mortality, acute on chronic heart failure, stroke, length of stay (LOS), and total cost in patients with to those without AF, stratified by subtype of AF.

Results: The prevalence of AF among patients with AL-CA was unchanged from 2015 to 2017 (50%-53%; adjusted odds ratio, 1.1 [0.9-1.5]; P = 0.3). The trend was unchanged in the stratified analysis by subtype of AF. Patients with AF were older and had more comorbidities. After propensity matching, acute on chronic heart failure was significantly higher in patients with AL-CA and AF, compared with those with AL-CA alone (55.6% vs. 48.3%; P < 0.0001). There was no difference in inhospital mortality (7.5% vs. 7.5%; P = 0.9), stroke (2.0% vs. 2.5%; P = 0.5), median LOS (5 [3-9] vs. 5 [3-8]; P = 0.3), and median total hospital cost $42,469 ([$21,309-$92,855] vs. $44,008 [$22,889-$94,200]; P = 0.6). In the stratified analysis, acute on chronic heart failure remained significant higher in patients with paroxysmal and nonparoxysmal AF, while LOS became significantly longer in patients with paroxysmal AF.

Conclusions: Among patients with AL-CA, AF is associated with a higher risk of acute on chronic heart failure.
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http://dx.doi.org/10.1097/HPC.0000000000000257DOI Listing
September 2021

Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study.

Circulation 2021 Jun 19;143(24):2355-2366. Epub 2021 Feb 19.

Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD (J.B.E.-T., R.R.K., G.S.W., S.H.C.).

Background: The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed.

Methods: ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring phenotypes, adjusting for important confounders.

Results: The mean age of participants was 59±11 years and 69% were female. In fully adjusted models, lower log-PRA was associated with higher clinic, awake, and asleep systolic BP and DBP (all <0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all <0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (odds ratio [OR] 0.59 [95% CI, 0.49-0.71]), nocturnal hypertension (OR, 0.68 [95% CI, 0.58-0.79]), daytime and nocturnal hypertension (OR, 0.59 [95% CI, 0.48-0.71]), sustained hypertension (OR, 0.52 [95% CI, 0.39-0.70]), and masked hypertension (OR 0.75 [95% CI, 0.62-0.90]). A 1-unit higher log-aldosterone was associated with higher odds of nocturnal hypertension (OR, 1.38 [95% CI, 1.05-1.81]). Neither PRA nor aldosterone was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA.

Conclusions: Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, in the clinic and during the awake and asleep periods. Further clinical investigation of novel and approved medications that target low renin physiology such as epithelial sodium channel inhibitors and mineralocorticoid receptor antagonists may be paramount in improving hypertension control in African Americans.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.050896DOI Listing
June 2021

Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus.

World J Cardiol 2021 Jan;13(1):11-20

Department of Cardiovascular Disease, University of Pennsylvania, Pennsylvania, PA 19104, United States.

Background: There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM).

Aim: To investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes.

Methods: We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block.

Results: Crude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% 35.6%; < 0.0001). After propensity matching, in-hospital mortality (11.1% 11.9%; < 0.0001), stroke (2.3% 3.0%; < 0.0001), acute heart failure (4.6% 6.5%; = 0.001), cardiogenic shock (1.5% 1.9%; < 0.0001), septic shock (7.2% 9.6%; < 0.0001), and atrioventricular block (1.5% 2.4%; < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.

Conclusion: There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.
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http://dx.doi.org/10.4330/wjc.v13.i1.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821010PMC
January 2021

Intravascular ultrasound-guided pulmonary artery embolectomy for saddle pulmonary embolism.

Catheter Cardiovasc Interv 2021 02 19;97(3):E385-E389. Epub 2020 May 19.

Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.

A percutaneous catheter-directed treatment approach is preferred among patients with acute submassive pulmonary embolism (PE) and chronic kidney disease (CKD), who are at significant risk of bleeding with thrombolytics. Limiting contrast volume in these patients could reduce morbidity and mortality associated with contrast-induced acute kidney injury (CI-AKI). We present the case of a 61-year-old African American woman (BMI 46.9 kg/m ) with multiple comorbidities, including a PE 3 years prior (not currently on anticoagulation) and CKD (GFR 33 ml/min/1.73/m ), presented to the emergency department with 3 weeks of dyspnea on exertion which worsened 3-5 days preceding her presentation. On examination, she was hemodynamically stable, oxygen saturation was 88% on 5 l, in mild respiratory distress with bilateral lower extremity pitting edema. Troponin was 0.06 ng/ml (ref. <0.04), B-type natriuretic peptide was 932 pg/ml (ref. ≤78), arterial oxygen partial pressure was 56 (ref. 80-110) and hemoglobin was 10.1 g/dl (ref. 11.3-15.0). Computed tomography pulmonary angiography performed with IV contrast showed a saddle embolus with evidence of right heart strain (RV/LV ratio: 2.05). A transthoracic echocardiogram showed a dilated RV and mean pulmonary artery pressure was 53 mmHg on right heart catheterization. She underwent a successful catheter-directed pulmonary embolectomy with the aid of an intravascular ultrasound (IVUS) along with fluoroscopy. To prevent CI-AKI, intravenous contrast was not used for the procedure. To the best of our knowledge, this is the first reported case of an "IVUS-only" approach in a patient with acute submassive PE and CKD.
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http://dx.doi.org/10.1002/ccd.28985DOI Listing
February 2021

Learning Styles of Internal Medicine Residents and Association With the In-Training Examination Performance.

J Natl Med Assoc 2020 Feb 3;112(1):44-51. Epub 2020 Feb 3.

Internal Medicine Residency Program, Morehouse School of Medicine, USA.

Introduction: Assessment of how medical residents learn and the impact on standardized test performance is important for effective training. Kolb's learning study inventory categorizes learning into accommodating, assimilating, converging and diverging based on the four stages of learning: active experimentation, abstract conceptualization, concrete experience and reflective observation. The American College of Physicians (ACP) Internal Medicine In-Training Examination (IM-ITE) has been shown to positively correlate with successful performance on clinical assessments and board certification. We sought to evaluate the association between the individual learning styles of IM residents and performance on the ACP IM-ITE.

Methods: The Kolb LSI questionnaire was administered to IM residents during the 2016/2017 academic year. Logistic regression was used to analyze the association between residents preferred learning styles and performance on the ACP IM - ITE.

Results: 53 residents in the IM Residency Program of Morehouse School of Medicine completed the questionnaire. The predominant learning style was assimilating (49%), followed by converging (26%). There was no significant difference between the learning styles of residents when compared across gender, age, race, and PGY levels. Residents with a diverging learning style had the highest mean IM-ITE percentage score followed by assimilating and converging respectively (P = 0.14) CONCLUSIONS: The predominant learning styles among our IM residents are assimilating and converging, which is consistent with previous studies. Residents with a diverging style of learning appeared to perform better on the IM-ITE. We suggest that future studies should evaluate the feasibility of integrating brainstorming and group work sessions into the IM residency teaching curriculum and the impact on academic performance.
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http://dx.doi.org/10.1016/j.jnma.2019.12.002DOI Listing
February 2020

Factors influencing the uptake of influenza vaccination in African American patients with heart failure: Findings from a large urban public hospital.

Heart Lung 2020 May - Jun;49(3):233-237. Epub 2020 Jan 23.

Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States.

Background: Evidence suggests that annual influenza vaccination may prevent acute heart failure exacerbation episodes and improve survival.

Objective: Determine the influenza vaccination rate among African American patients with heart failure and identify predictors of uptake.

Methods: African American patients with heart failure were recruited at Grady Memorial Hospital, Atlanta GA between October 1, 2017 and April 28, 2018 (N = 281). All participants completed a questionnaire.

Results: Mean age of the sample was 50.5 ± 11.5 years (58% male). The influenza vaccination rate among the patients was 46% (n = 129/281). Patients who received vaccination information and recommendation from their physician, especially cardiologists, were significantly more likely to be vaccinated than those who did not (P<0.05). Major reasons for declining vaccination included fear of getting sick from influenza vaccine and distrust of the pharmaceutical companies that produce vaccines.

Conclusions: Recommendation of influenza vaccines by physicians during medical consultations and cardiology visits may improve uptake rates in heart failure patients.
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http://dx.doi.org/10.1016/j.hrtlng.2019.12.003DOI Listing
December 2020

The association between health care coverage and prevalence of cardiovascular diseases and diabetes over a 10-year period.

Prev Med 2020 03 16;132:105983. Epub 2020 Jan 16.

Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America.

Persons without health care coverage have poorer health outcomes. We investigated the association between health care coverage and trends in the prevalence of cardiovascular disease (CVD) and diabetes pre- and post-Affordable Care Act (ACA) periods. Using data from 3,824,678 surveyed adults in the Behavioral Risk Factor Surveillance System survey from 2007 - 2016, we calculated the yearly prevalence of CVD and diabetes. Using logistic regression, we investigated the association between health care coverage and CVD and diabetes, controlling for sociodemographic factors (age, sex, race, marital status, education and income). The mean age of participants was 55.3 ± 18.9 years. Health care coverage increased from 88.6% in 2007 to 93% in 2016. The prevalence of CVD and diabetes increased from pre- to post-ACA periods. After adjustment, in pre-ACA period, the odds ratio (OR) for the association between health care coverage and CVD and diabetes was 1.32 (95% CI:1.30-1.34) and 1.44 (95% CI:1.41-1.46), respectively; in the post-ACA period, the OR was 1.26 (95% CI:1.22-1.30) and 1.48 (95% CI:1.44-1.52), respectively. We found a significant association between health care coverage and trends in the prevalence of CVD and diabetes in the pre- and post-ACA periods.
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http://dx.doi.org/10.1016/j.ypmed.2020.105983DOI Listing
March 2020

Bladder necrosis and perforation in end-stage renal disease and recurrent urinary tract infection: A rare medical emergency.

Int J Crit Illn Inj Sci 2019 Apr-Jun;9(2):101-104

Department of Gastroenterology, Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA.

Bladder necrosis and perforation is a rare and life-threatening medical emergency. Risk factors include trauma, malignancy, previous surgery and/or radiation therapy and diabetes mellitus. Signs, symptoms, and imaging findings are often obscure making the diagnosis difficult. Urinary tract infection is common in end-stage renal disease (ESRD) patients who have residual urine production and associated with increased complication and mortality rates. We describe the case of a 57-year-old female with a medical history of recurrent cystitis, type 2 diabetes mellitus and ESRD on hemodialysis that was admitted for septic shock and presumed ischemic colitis. Urine and blood microbiology studies were notable for . By the second day of hospital admission, her clinical condition significantly deteriorated and was later found to have bladder necrosis and rupture during laparotomy for suspected peritonitis. It is important that clinicians recognize bladder rupture as a potential complication of recurrent bacterial cystitis in ESRD patients on dialysis.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_72_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625330PMC
July 2019

Letter to the Editor Re: Effect of food intake and ambient air pollution exposure on ankylosing spondylitis disease activity.

Adv Rheumatol 2019 06 17;59(1):22. Epub 2019 Jun 17.

Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.

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http://dx.doi.org/10.1186/s42358-019-0065-9DOI Listing
June 2019

The Association of Life's Simple 7 with Aldosterone among African Americans in the Jackson Heart Study.

Nutrients 2019 Apr 26;11(5). Epub 2019 Apr 26.

Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.

Background: Among African Americans (AAs), attaining higher levels of American Heart Association (AHA) ideal cardiovascular health (Life's Simple 7 [LS7]) is associated with lower risk of diabetes and cardiovascular disease (CVD). We previously showed that aldosterone is associated with higher risk of diabetes and CVD in AAs. Thus, we investigated the association of LS7 metrics with aldosterone in the Jackson Heart Study (JHS).

Methods: Ideal metrics were defined by AHA 2020 goals for health behaviors (smoking, dietary intake, physical activity, and body mass index) and health factors (total cholesterol, blood pressure, and fasting glucose). The number of ideal LS7 metrics attained at baseline were summed into a continuous score (0-7) and categorical groups (Poor: 0-1, Intermediate: 2-3, and Ideal: ≥4 ideal LS7 metrics). Multivariable linear regression was used.

Results: Among 4,095 JHS participants (mean age 55 ± 13 years, 65% female), median serum aldosterone was 4.90, 4.30, and 3.70 ng/dL in the poor ( = 1132), intermediate ( = 2288) and ideal ( = 675) categories respectively. Aldosterone was 15% [0.85 (0.80, 0.90)] and 33% [0.67 (0.61, 0.75)] lower in the intermediate and ideal LS7 categories compared to the poor LS7 category. Each additional LS7 metric attained on continuous LS7 score (0-7) was associated with an 11% [0.89 (0.86, 0.91)] lower aldosterone level with variation by sex with women having a 15% lower aldosterone vs. 5% in men.

Conclusions: Higher attainment of ideal LS7 metrics was associated with lower serum aldosterone among AAs with a greater magnitude of association among women compared to men.
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http://dx.doi.org/10.3390/nu11050955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566676PMC
April 2019

Glycemic Markers and Subclinical Cardiovascular Disease: The Jackson Heart Study.

Circ Cardiovasc Imaging 2019 03;12(3):e008641

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.).

Background We investigated the associations of glycemic markers (HbA [hemoglobin A], fasting plasma glucose, and insulin resistance-homeostasis model assessment of insulin resistance) with subclinical cardiovascular disease (CVD) among blacks. Methods We included 4303 community-dwelling blacks (64% women; mean age, 54.5 years) without prevalent CVD. Subclinical CVD was defined as ≥1 of the following: any coronary artery calcification (CAC), elevated carotid intima-media thickness (cIMT), left ventricular (LV) hypertrophy, LV ejection fraction <50%, and peripheral artery disease (ankle-brachial index, <0.90). Estimates of cross-sectional associations of glycemic markers (fasting plasma glucose, HbA, and homeostasis model assessment of insulin resistance) with subclinical CVD measures were adjusted for traditional CVD risk factors. Results Each 1% increment in HbA was associated with higher odds of CAC, abnormal cIMT, and subclinical CVD (all P <0.001). Adjusted mean values of LV mass (LVM), LVM index, relative wall thickness, CAC, and cIMT were increasingly abnormal with worsening HbA categories (all P<0.05). Each 10-mg/dL increase in fasting plasma glucose was associated with higher odds of LV hypertrophy, CAC, abnormal cIMT, and subclinical CVD (all P <0.005). Adjusted mean values of LVM, LVM index, relative wall thickness, CAC, ankle-brachial index, and cIMT were more abnormal across categories of worsening fasting plasma glucose (all P <0.05). Each unit increment in log-transformed homeostasis model assessment of insulin resistance conferred a higher odd of having LV hypertrophy ( P<0.01). Across quartiles of homeostasis model assessment of insulin resistance, we observed progressively abnormal adjusted mean values of LVM, LVM index, relative wall thickness, and ankle-brachial index (all P <0.01). Conclusions Among blacks, glycemic markers were differentially associated with various measures of subclinical CVD.
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http://dx.doi.org/10.1161/CIRCIMAGING.118.008641DOI Listing
March 2019

Further Considerations on the Benefits of Thiamine Administration in Patients With Septic Shock.

Crit Care Med 2019 02;47(2):e153-e154

Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, and Grady Memorial Hospital, Atlanta, GA; Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, and Grady Memorial Hospital, Atlanta, GA, and Division of Pulmonary and Critical Care, Morehouse School of Medicine, Atlanta, GA.

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http://dx.doi.org/10.1097/CCM.0000000000003450DOI Listing
February 2019

Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Diabetologia 2019 03 15;62(3):426-437. Epub 2019 Jan 15.

Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.

Aims/hypothesis: Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6-6.9 mmol/l]).

Methods: A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003-2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0-1, 2-3 and ≥4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors.

Results: Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with ≥4 vs 0-1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk (RR 0.20; 95% CI 0.10, 0.37), while participants with baseline IFG (n = 1754) had 13% lower risk (RR 0.87; 95% CI 0.58, 1.30) (p for interaction by baseline glucose status <0.0001). Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338).

Conclusions/interpretation: A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.
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http://dx.doi.org/10.1007/s00125-018-4792-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392040PMC
March 2019

In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample: Does Telemetry Monitoring Have a Role to Play?

Crit Care Med 2018 12;46(12):e1229-e1230

Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, and Grady Memorial Hospital, Atlanta, GA.

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http://dx.doi.org/10.1097/CCM.0000000000003404DOI Listing
December 2018

Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA.

J Am Heart Assoc 2018 09;7(17):e009890

5 Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore MD.

Background Mechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross-sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance ( IR ), β-cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study. Methods and Results Homeostatic model assessment of IR ( HOMA 2- IR ) and HOMA 2-β were used to estimate IR and β-cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti-diabetic medication use at follow-up. Linear regression was used to examine cross-sectional associations of aldosterone with fasting plasma glucose, HOMA 2- IR and HOMA 2-β; Cox regression was used to estimate hazard ratios ( HR ) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non-Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log-aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA 2- IR and 6% higher HOMA 2-β ( P<0.01). A 1- SD increase in log-aldosterone was associated with a 44% higher risk of incident diabetes mellitus ( P<0.01) with the greatest increase of 142% ( P<0.01) observed in Chinese Americans ( P for interaction=0.09 versus other ethnicities). Similar cross-sectional findings for log-plasma renin activity existed, but log-plasma renin activity was not associated with incident diabetes mellitus after full adjustment. Conclusions Aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation.
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http://dx.doi.org/10.1161/JAHA.118.009890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201432PMC
September 2018

Intestinal ultrasound in assessment of suspected Crohn's disease in patients with negative ileocolonoscopy: a paradigm shift?

Therap Adv Gastroenterol 2018 12;11:1756284818787397. Epub 2018 Jul 12.

Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.

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http://dx.doi.org/10.1177/1756284818787397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047238PMC
July 2018

Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use.

J Cardiovasc Pharmacol Ther 2018 11 24;23(6):518-523. Epub 2018 May 24.

2 Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.

Background: β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use.

Methods: We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure-related readmissions.

Results: The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions.

Conclusion: The BBT reduced 30-day, all-cause and heart failure-related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.
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http://dx.doi.org/10.1177/1074248418778550DOI Listing
November 2018

Comparison of Measures of Adiposity and Cardiovascular Disease Risk Factors Among African American Adults: the Jackson Heart Study.

J Racial Ethn Health Disparities 2018 12 9;5(6):1230-1237. Epub 2018 Feb 9.

Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.

Obesity, particularly central adiposity, is a well-established risk factor for cardiovascular disease (CVD). Waist circumference (WC) is measured in numerous epidemiologic studies as a relatively simple indicator of central adiposity. However, recently, investigators have considered a measure that takes height into consideration, waist-to-height ratio (WHtR) as a more sensitive predictor of CVD. A limited number of studies have examined the association between various measures of central adiposity and obesity with CVD, but there is a dearth of information on this topic focused specifically on African American adults. Given the high rates of cardiovascular disease and metabolic risk factors in this population, it is important to develop validated, easy-to-measure indicators of CVD risk for clinical use. Data from 4758 African American adults participating in the baseline visit of the Jackson Heart Study with available risk factor data were examined, with three measures of body habitus (body mass index (BMI), WC, and WHtR) and five CVD risk factors (HDL and LDL cholesterol, triglycerides, diabetes, and hypertension), the latter also categorized into multiple (2+) risk factors present. C-statistics for waist circumference (WC), BMI, and WHtR were computed and compared for each model to assess their discriminant abilities. WHtR was a stronger correlate of HDL cholesterol, triglycerides, diabetes, hypertension, and multiple risk factors compared to BMI, and was a stronger correlate of HDL cholesterol when compared to WC. These data indicate that, for African American adults, WHtR may be more appropriate measure to identify those at elevated risk for CVD.
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http://dx.doi.org/10.1007/s40615-018-0469-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085149PMC
December 2018

Aldosterone, Renin, Cardiovascular Events, and All-Cause Mortality Among African Americans: The Jackson Heart Study.

JACC Heart Fail 2017 09 16;5(9):642-651. Epub 2017 Aug 16.

Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Objectives: This study examined the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD), using a composite endpoint of coronary heart disease, stroke, and/or heart failure and mortality among African Americans in the Jackson Heart Study.

Background: There is a paucity of data for the association of aldosterone and PRA with incident CVD or all-cause mortality among community-dwelling African Americans.

Methods: A total of 4,985 African American adults, 21 to 94 years of age, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (from 2000 to 2004). Incident events included coronary heart disease and stroke (assessed from 2000 to 2011) and heart failure (assessed from 2005 to 2011). Cox models were used to estimate hazard ratios (HRs) for incident CVD and mortality, adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake, and body mass index.

Results: Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HR of 1.26 (95% confidence intervals [CI]: 1.14 to 1.40) and 1.16 (95% CI: 1.02 to 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04 to 1.23) and 1.12 (95% CI: 1.01 to 1.24) for mortality, respectively.

Conclusions: Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among African Americans.
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http://dx.doi.org/10.1016/j.jchf.2017.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705009PMC
September 2017

Multiple jejunal perforation secondary to intestinal tuberculosis infection: a case report.

Pan Afr Med J 2017 2;27:78. Epub 2017 Jun 2.

Department of Surgery, Baptist Hospital Mutengene, Cameroon.

Abdominal tuberculosis (TB) may affect any part of the gastrointestinal tract resulting in significant morbidity and mortality. There is an increase in the incidence of abdominal TB favored by the emergence of multi-drug resistant Mycobacterium tuberculosis and immunosuppression especially from HIV co-infection. Our case is that of a 31 year old HIV-positive woman, adherent to antiretroviral therapy, who presented with a 2 month history of progressive abdominal distention, drenching night sweat and fatigue, but without fever. She was admitted on a presumptive diagnosis of peritoneal TB, and suddenly developed signs and symptoms of an acute abdomen. Laboratory investigations showed a CD4+ count of 155 cells/µL, white blood cell count of 15,700 cells/mm and haemoglobin of 8.0g/dl. An emergency laparotomy revealed small bowel caseous necrosis with multiple jejunal perforations. Ziehl-Nelsen staining of operative specimen was positive for acid fast bacilli. Given her immunodeficiency status, clinical signs and symptoms, CD4 cell count > 50 cells/µL, and intestinal sample showing caseous necrosis and perforations, a final diagnosis of intestinal TB was made. In conclusion, abdominal tuberculosis may mimic a number of intra-abdominal pathologies; thus should always be considered as a differential diagnosis in patients presenting with acute abdomen in TB-endemic areas especially in an HIV-positive individual.
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http://dx.doi.org/10.11604/pamj.2017.27.78.11061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554641PMC
September 2017

Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans.

Am J Prev Med 2017 Nov 14;53(5):e165-e174. Epub 2017 Aug 14.

Johns Hopkins University, School of Medicine, Baltimore, Maryland.

Introduction: The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs.

Methods: Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016.

Results: Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30.

Conclusions: A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity.
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http://dx.doi.org/10.1016/j.amepre.2017.06.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704929PMC
November 2017

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study.

J Am Heart Assoc 2017 Jun 21;6(6). Epub 2017 Jun 21.

Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.

Background: The concept of ideal cardiovascular health (CVH), defined by the American Heart Association primarily for coronary heart disease and stroke prevention, may apply to diabetes mellitus prevention among blacks.

Methods And Results: Our sample included 2668 adults in the Jackson Heart Study with complete baseline data on 6 of 7 American Heart Association CVH metrics (body mass index, healthy diet, smoking, total cholesterol, blood pressure, and physical activity). Incident diabetes mellitus was defined as fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes mellitus drugs, or glycosylated hemoglobin ≥6.5%. A summary CVH score from 0 to 6, based on presence/absence of ideal CVH metrics, was derived for each participant. Cox regression was used to estimate adjusted hazard ratios. Mean age was 55 years (65% women) with 492 incident diabetes mellitus events over 7.6 years (24.6 cases/1000 person-years). Three quarters of participants had only 1 or 2 ideal CVH metrics; no participant had all 6. After adjustment for demographic factors (age, sex, education, and income) and high-sensitivity C-reactive protein, each additional ideal CVH metric was associated with a 17% diabetes mellitus risk reduction (hazard ratio, 0.83; 95% CI, 0.74-0.93). The association was attenuated with further adjustment for homeostasis model assessment for insulin resistance (hazard ratio, 0.89; 95% CI, 0.79-1.00). Compared with participants with 1 or no ideal CVH metric, diabetes mellitus risk was 15% and 37% lower in those with 2 and ≥3 ideal CVH metrics, respectively.

Conclusions: The AHA concept of ideal CVH is applicable to diabetes mellitus prevention among blacks. These associations were largely explained by insulin resistance.
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http://dx.doi.org/10.1161/JAHA.116.005008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669153PMC
June 2017

Diabetes status modifies the association between carotid intima-media thickness and incident heart failure: The Atherosclerosis Risk in Communities study.

Diabetes Res Clin Pract 2017 Jun 13;128:58-66. Epub 2017 Apr 13.

Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.

Aims: Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status.

Methods: We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100mg/dl), impaired fasting glucose (IFG, glucose 100-125mg/dl), and type 2 diabetes (T2D, glucose ≥126mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD.

Results: T2D participants had higher mean CIMT (0.79±0.20mm), compared to IFG (0.75±0.19mm) and NFG (0.70±0.17mm) (p<0.0001). Over 20.6years of median follow-up, 15% developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (P=0.015): for NFG (HR per SD increase in CIMT: 1.27; 95%CI: 1.20-1.34), IFG (HR 1.18; 95%CI: 1.11-1.25) and T2D (HR 1.12; 95%CI: 1.05-1.21).

Conclusions: CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.
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http://dx.doi.org/10.1016/j.diabres.2017.04.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501651PMC
June 2017
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