Publications by authors named "Oladipupo Olafiranye"

33 Publications

Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future.

Circulation 2021 Jun 14;143(24):2395-2405. Epub 2021 Jun 14.

School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.).

In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.053566DOI Listing
June 2021

Rationale and Design for the Remote Ischemic Preconditioning for Carotid Endarterectomy Trial.

Ann Vasc Surg 2019 Oct 12;60:246-253. Epub 2019 Jun 12.

UPMC, Division of Vascular Surgery, Pittsburgh, PA.

Background: While the perioperative stroke rate after carotid endarterectomy (CEA) is low, "silent" microinfarctions identified by magnetic resonance imaging (MRI) are common and have been correlated with postoperative neurocognitive decline. Our study will investigate the role of remote ischemic preconditioning (RIPC) as a potential neuroprotective mechanism. RIPC is a well-tolerated stimulus that, through neuronal and humoral pathways, generates a systemic environment of greater resistance to subsequent ischemic insults. We hypothesized that patients undergoing RIPC before CEA will have improved postoperative neurocognitive scores compared with those of patients undergoing standard care.

Methods: Patients undergoing CEA will be randomized 1:1 to RIPC or standard clinical care. Those randomized to RIPC will undergo a standard protocol of 4 cycles of RIPC. Each RIPC cycle will involve 5 min of forearm ischemia with 5 min of reperfusion. Forearm ischemia will be induced by a blood pressure cuff inflated to 200 mm Hg or at least 15 mm Hg higher than the systolic pressure if it is >185 mm Hg. This will occur after anesthesia induction and during incision/dissection but before manipulation or clamping of the carotid; thus, patients will be blinded to their assignment. Before carotid endarterectomy, all patients will undergo baseline neurocognitive testing in the form of a Montreal Cognitive Assessment (MoCA) and National Institutes of Health (NIH) Toolbox. MoCA testing only will be conducted on postoperative day 1 in the hospital. The full neurocognitive testing battery will again be conducted at 1-month follow-up in the office. Changes from baseline will be compared between arms at the follow-up time points. Assuming no drop-ins or dropouts and a 10% loss to follow-up, we would need a sample size of 43 patients for 80% power per treatment arm. The primary endpoint, change in MoCA scores, will be analyzed using a random effects model, and secondary outcomes will be analyzed using either linear or logistic regression where appropriate.

Conclusions: RIPC, if shown to be effective in protecting patients from neurocognitive decline after CEA, represents a safe, inexpensive, and easily implementable method of neuroprotection.
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http://dx.doi.org/10.1016/j.avsg.2019.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764906PMC
October 2019

Association between ideal cardiovascular health and markers of subclinical cardiovascular disease.

Clin Cardiol 2018 Dec 3;41(12):1593-1599. Epub 2018 Dec 3.

Department of Medicine, Providence VA Medical Center, Providence, Rhode Island.

Background: Ideal cardiovascular health (CVH) was proposed by the American Heart Association to promote population health. We aimed to characterize the association between ideal CVH and markers of subclinical cardiovascular disease (CVD).

Hypothesis: We hypothesized that ideal CVH is associated with several markers of subclinical CVD.

Methods: We used data from the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study. We assigned 1 for each of the ideal CVH factors met. Endothelial function, expressed as Framingham reactive hyperemia index (fRHI), was measured using the EndoPAT device. Coronary artery calcium (CAC) and carotid intima-media thickness (CIMT) were quantified using electron beam computed tomography and carotid ultrasonography, respectively.

Results: A total of 1933 participants (mean [SD] age: 59 [7.5] years, 34% male, 44% black) were included. The mean number of ideal CVH factors met was 2.3 ± 1.3, with blacks having significantly lower score compared to whites (2.0 ± 1.2 vs 2.5 ± 1.4, respectively; P < 0.001). Seven hundred and eighty-nine participants (41%) achieved ≥3 ideal CVH factors. Participants with ≥3 ideal CVH factors (compared to those with <3 factors) had an average of 107 (95% confidence interval [CI]: 50-165) Agatston units lower CAC, 0.04 (0.01-0.06) mm lower CIMT, and 0.07 (0.02-0.12) units higher fRHI, after adjusting for age, sex, race, income, education, and marital status. Participants with ≥3 ideal CVH factors had 50% lower odds (95% CI: 28%-66%) of having CAC >100 Agatston units.

Conclusion: In a community-based study with low prevalence of ideal CVH, even achieving three or more ideal CVH factors were associated with lower burden of subclinical CVD, indicating the utility of this construct for disease prevention.
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http://dx.doi.org/10.1002/clc.23096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490110PMC
December 2018

Particulate Matter Air Pollution and Racial Differences in Cardiovascular Disease Risk.

Arterioscler Thromb Vasc Biol 2018 04 15;38(4):935-942. Epub 2018 Mar 15.

From the Department of Medicine, University of Pittsburgh, PA (S.E., O.O., J.W.M., A.A., S.E.R.); Department of Environmental Health, University of Pittsburgh Graduate School of Public Health, PA (J.E.C., S.T.); Department of Environmental Health, Drexel University Dornsife School of Public Health, Philadelphia, PA (J.E.C., S.T.); and College of Public Health, University of South Florida, Tampa (K.E.P.).

Objective: We aimed to assess racial differences in air pollution exposures to ambient fine particulate matter (particles with median aerodynamic diameter <2.5 µm [PM]) and black carbon (BC) and their association with cardiovascular disease (CVD) risk factors, arterial endothelial function, incident CVD events, and all-cause mortality.

Approach And Results: Data from the HeartSCORE study (Heart Strategies Concentrating on Risk Evaluation) were used to estimate 1-year average air pollution exposure to PM and BC using land use regression models. Correlates of PM and BC were assessed using linear regression models. Associations with clinical outcomes were determined using Cox proportional hazards models, adjusting for traditional CVD risk factors. Data were available on 1717 participants (66% women; 45% blacks; 59±8 years). Blacks had significantly higher exposure to PM (mean 16.1±0.75 versus 15.7±0.73µg/m; =0.001) and BC (1.19±0.11 versus 1.16±0.13abs; =0.001) compared with whites. Exposure to PM, but not BC, was independently associated with higher blood glucose and worse arterial endothelial function. PM was associated with a higher risk of incident CVD events and all-cause mortality combined for median follow-up of 8.3 years. Blacks had 1.45 (95% CI, 1.00-2.09) higher risk of combined CVD events and all-cause mortality than whites in models adjusted for relevant covariates. This association was modestly attenuated with adjustment for PM.

Conclusions: PM exposure was associated with elevated blood glucose, worse endothelial function, and incident CVD events and all-cause mortality. Blacks had a higher rate of incident CVD events and all-cause mortality than whites that was only partly explained by higher exposure to PM.
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http://dx.doi.org/10.1161/ATVBAHA.117.310305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864550PMC
April 2018

Association of obstructive sleep apnea with microvascular endothelial dysfunction and subclinical coronary artery disease in a community-based population.

Vasc Med 2018 08 14;23(4):331-339. Epub 2018 Mar 14.

1 Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Studies have reported an association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) morbidity and mortality. Proposed mechanisms include endothelial dysfunction and atherosclerosis. We aimed to investigate the associations of OSA with endothelial dysfunction and subclinical atherosclerotic coronary artery disease (CAD), and assess the impact of race on these associations. We used data from the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, a community-based prospective cohort with approximately equal representation of black and white participants. OSA severity was measured in 765 individuals using the apnea-hypopnea index (AHI). Endothelial dysfunction was measured using the Endo-PAT device, expressed as Framingham reactive hyperemia index (F_RHI). Coronary artery calcium (CAC), a marker of subclinical CAD, was quantified by electron beam computed tomography. There were 498 (65%) female participants, 282 (37%) black individuals, and 204 (26%) participants with moderate/severe OSA (AHI ≥15). In univariate models, moderate/severe OSA was associated with lower F_RHI and higher CAC, as well as several traditional CVD risk factors including older age, male sex, hypertension, diabetes, higher body mass index, and lower high-density lipoprotein cholesterol levels. In a multivariable model, individuals with moderate/severe OSA had 10% lower F_RHI and 35% higher CAC, which did not reach statistical significance ( p=0.08 for both comparisons). There was no significant interaction of race on the association of OSA with F_RHI or CAC ( p-value >0.1 for all comparisons). In a community-based cohort comprised of black and white participants, moderate/severe OSA was modestly associated with endothelial dysfunction and subclinical atherosclerotic CAD. These associations did not vary by race.
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http://dx.doi.org/10.1177/1358863X18755003DOI Listing
August 2018

Ischemic Postconditioning During Primary Percutaneous Coronary Intervention: Is Smoker's Paradox in Play?

JAMA Cardiol 2017 09;2(9):1049-1050

Division of Cardiology, Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.

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http://dx.doi.org/10.1001/jamacardio.2017.2468DOI Listing
September 2017

Contrast-induced acute kidney injury in interventional cardiology: Emerging evidence and unifying mechanisms of protection by remote ischemic conditioning.

Cardiovasc Revasc Med 2017 Oct - Nov;18(7):549-553. Epub 2017 Jun 6.

Heart and Vascular Institute, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address:

Contrast-induced acute kidney injury (CI-AKI) is a common complication of many diagnostic and therapeutic cardiovascular procedures. It is associated with longer in-hospital stay, more complicated hospitalization course, and higher in-hospital morbidity and mortality. With increasing use of contrast media in various diagnostic and interventional procedures, the prevalence of CI-AKI is expected to rise. Although pre-hydration with intravenous normal saline is recommended in patients with elevated risk of CI-AKI, this approach is often not feasible in many clinical settings. Remote ischemic conditioning (RIC), elicited by application of one or more, brief, non-injurious episodes of ischemia and reperfusion of a limb, is a promising therapy for preventing or attenuating the deleterious effects of contrast media on the kidney. Although the mechanisms of protection by RIC have not been completely defined, complex humoral, neural, and inflammatory pathways have been hypothesized to be in play. Given that RIC is non-invasive and cheap, it is attractive from clinical and economic perspective as a therapy to protect the kidney from CI-AKI. In this succinct review, we highlight the unifying mechanisms of CI-AKI and provide an overview of proposed biological mechanisms of renal protection by RIC. Emerging pre-clinical and clinical evidence in interventional cardiology is also discussed.
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http://dx.doi.org/10.1016/j.carrev.2017.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650932PMC
June 2018

Association of remote ischemic peri-conditioning with reduced incidence of clinical heart failure after primary percutaneous coronary intervention.

Cardiovasc Revasc Med 2017 Mar 15;18(2):105-109. Epub 2016 Dec 15.

Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Background: Clinical heart failure (HF) occurs frequently after ST-segment elevation myocardial infarction (STEMI), and is associated with increased mortality. We assessed the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of STEMI patients on clinical HF following primary percutaneous coronary intervention (pPCI).

Methods: Data from Acute Coronary Treatment and Intervention Outcomes Network Registry®-Get With the Guidelines™ (ACTION Registry-GWTG) from two PCI-hospitals that are utilizing RIPC during inter-facility helicopter transport of STEMI patients for pPCI between March, 2013 and September, 2015 were used for this study. The analyses were limited to inter-facility STEMI patients transported by helicopter with LVEF <55% after pPCI. The outcome measures were occurrence of clinical HF and serum level of brain-type natriuretic peptide (BNP).

Results: Out of the 150 STEMI patients in this analysis, 92 patients received RIPC and 58 did not. The RIPC and non-RIPC groups were generally similar in demographic and clinical characteristics except for lower incidence of cardiac arrest in the RIPC group (3/92 [3.3%] versus 13/58 [22.4%], p=0.002). STEMI patients who received RIPC were less likely to have in-hospital clinical HF compared to patients who did not receive RIPC (3/92 [3.3%] versus 7/58 [12.1%]; adjusted OR=0.22, 95% CI 0.05-0.92, p=0.038) after adjusting for baseline differences. In subgroup analysis, RIPC was associated with lower BNP (123 [interquartile range, 17.0-310] versus 319 [interquartile range, 106-552], p=0.029).

Conclusion: RIPC applied during inter-facility air transport of STEMI patients for pPCI is associated with reduced incidence of clinical HF and serum BNP.
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http://dx.doi.org/10.1016/j.carrev.2016.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350037PMC
March 2017

Renal Protection Using Remote Ischemic Peri-Conditioning During Inter-Facility Helicopter Transport of Patients With ST-Segment Elevation Myocardial Infarction: A Retrospective Study.

J Interv Cardiol 2016 Dec 4;29(6):603-611. Epub 2016 Nov 4.

Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Objective: To assess the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of ST-segment elevation myocardial infarction (STEMI) patients on the incidence of acute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI).

Background: STEMI patients who receive pPCI have an increased risk of AKI for which there is no well-defined prophylactic therapy in the setting of emergent pPCI.

Methods: Using the ACTION Registry-GWTG, we evaluated the impact of RIPC applied during inter-facility helicopter transport of STEMI patients from non-PCI capable hospitals to 2 PCI-hospitals in the United States between March, 2013 and September, 2015 on the incidence of AKI following pPCI. AKI was defined as ≥0.3 mg/dL increase in creatinine within 48-72 hours after pPCI.

Results: Patients who received RIPC (n = 127), compared to those who did not (n = 92), were less likely to have AKI (11 of 127 patients [8.7%] vs. 17 of 92 patients [18.5%]; adjusted odds ratio = 0.32, 95% CI 0.12-0.85, P = 0.023) and all-cause in-hospital mortality (2 of 127 patients [1.6%] vs. 7 of 92 patients [7.6%]; adjusted odds ratio = 0.14, 95% CI 0.02-0.86, P = 0.034) after adjusting for socio-demographic and clinical characteristics. There was no difference in hospital length of stay (3 days [interquartile range, 2-4] vs. 3 days [interquartile range, 2-5], P = 0.357) between the 2 groups.

Conclusion: RIPC applied during inter-facility helicopter transport of STEMI patients for pPCI is associated with lower incidence of AKI and in-hospital mortality. The use of RIPC for renal protection in STEMI patients warrants further in depth investigation.
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http://dx.doi.org/10.1111/joic.12351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133150PMC
December 2016

Impact of race and obesity on arterial endothelial dysfunction associated with sleep apnea: Results from the Heart SCORE study.

Int J Cardiol 2015 Dec 13;201:476-8. Epub 2015 Aug 13.

Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1016/j.ijcard.2015.08.098DOI Listing
December 2015

Feasibility of Remote Ischemic Peri-conditioning during Air Medical Transport of STEMI Patients.

Prehosp Emerg Care 2016 13;20(1):82-9. Epub 2015 Aug 13.

Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during air medical transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state air medical service over 16 months (March 2013 to June 2014). Eligible patients were transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by air medical transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure <90 mmHg) during the procedure. RIPC was initiated in 99 patients (91 interfacility, 8 scene transports) and 83 (83.3%) received 3 or 4 cycles of RIPC, delivered over 25-35 minutes. Median bedside time for interfacility transfers was 8 minutes (IQR 7, 10). More than half of patients reported no pain related to the procedure (N = 53, 53.3%), whereas 5 (5.1%) patients reported discomfort greater than 5 out of 10. Two patients developed hypotension while receiving RIPC and both had experienced hypotension prior to initiation of RIPC. RIPC is feasible and safe to implement for STEMI patients undergoing air medical transport for pPCI, without occurrence of prolonged bedside times. The incidence of excessive RIPC-related discomfort or hemodynamic instability is rare. STEMI patients requiring on average >30 minutes transport for pPCI may be the ideal group for RIPC utilization.
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http://dx.doi.org/10.3109/10903127.2015.1056894DOI Listing
October 2016

Effect of aspirin on acute changes in peripheral arterial stiffness and endothelial function following exertional heat stress in firefighters: The factorial group results of the Enhanced Firefighter Rehab Trial.

Vasc Med 2015 Jun 4;20(3):230-6. Epub 2015 May 4.

The Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.

Peripheral arterial stiffness and endothelial function, which are independent predictors of cardiac events, are abnormal in firefighters. We examined the effects of aspirin on peripheral arterial stiffness and endothelial function in firefighters. Fifty-two firefighters were randomized to receive daily 81 mg aspirin or placebo for 14 days before treadmill exercise in thermal protection clothing, and a single dose of 325 mg aspirin or placebo immediately following exertion. Peripheral arterial augmentation index adjusted for a heart rate of 75 (AI75) and reactive hyperemia index (RHI) were determined immediately before, and 30, 60, and 90 minutes after exertion. Low-dose aspirin was associated with lower AI75 (-15.25±9.25 vs -8.08±10.70, p=0.014) but not RHI. On repeated measures analysis, treatment with low-dose aspirin before, but not single-dose aspirin after exertion, was associated with lower AI75 following exertional heat stress (p=0.018). Low-dose aspirin improved peripheral arterial stiffness and wave reflection but not endothelial function in firefighters.
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http://dx.doi.org/10.1177/1358863X15571447DOI Listing
June 2015

Comparison of long-term safety and efficacy outcomes after drug-eluting and bare-metal stent use across racial groups: Insights from NHLBI Dynamic Registry.

Int J Cardiol 2015 Apr 27;184:79-85. Epub 2015 Jan 27.

Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.

Background: Long-term data on outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and bare-metal stent (BMS) across racial groups are limited, and minorities are under-represented in existing clinical trials. Whether DES has better long-term clinical outcomes compared to BMS across racial groups remains to be established. Accordingly, we assessed whether longer-term clinical outcomes are better with DES compared to BMS across racial groups.

Methods: Using the multicenter National Heart, Lung, and Blood Institute (NHLBI)-sponsored Dynamic Registry, 2-year safety (death, MI) and efficacy (repeat revascularization) outcomes of 3326 patients who underwent PCI with DES versus BMS were evaluated.

Results: With propensity-score adjusted analysis, the use of DES, compared to BMS, was associated with a lower risk for death or MI at 2 years for both blacks (adjusted Hazard Ratio (aHR)=0.41, 95% CI 0.25-0.69, p<0.001) and whites (aHR=0.67, 95% CI 0.51-0.90, p=0.007). DES use was associated with a significant 24% lower risk of repeat revascularization in whites (aHR=0.76, 95% CI 0.60-0.97, p=0.03) and with nominal 34% lower risk in blacks (aHR=0.66, 95% CI 0.39-1.13, p=0.13).

Conclusion: The use of DES in PCI was associated with better long-term safety outcomes across racial groups. Compared to BMS, DES was more effective in reducing repeat revascularization in whites and blacks, but this benefit was attenuated after statistical adjustment in blacks. These findings indicate that DES is superior to BMS in all patients regardless of race. Further studies are needed to determine long-term outcomes across racial groups with newer generation stents.
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http://dx.doi.org/10.1016/j.ijcard.2015.01.071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417363PMC
April 2015

Sleep apnea and subclinical myocardial injury: where do we stand?

Am J Respir Crit Care Med 2013 Dec;188(12):1394-5

1 Heart, Lung, Blood and Vascular Medicine Institute University of Pittsburgh Medical Center Pittsburgh, Pennsylvania and Department of Medicine University of Pittsburgh Pittsburgh, Pennsylvania.

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http://dx.doi.org/10.1164/rccm.201310-1923EDDOI Listing
December 2013

Sleep duration and reported functional capacity among black and white US adults.

J Clin Sleep Med 2013 Jun 15;9(6):605-9. Epub 2013 Jun 15.

Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Objective: Evidence suggests that individuals reporting sleeping below or above the population's modal sleep duration are at risk for diabetes, hypertension, and other cardiovascular diseases. Evidence also indicates that individuals with these conditions have reduced functional capacity. We assessed whether reported sleep duration and functional capacity are independently associated and whether individuals' race/ethnicity has an effect on this association.

Method: Data were obtained from 29,818 black and white Americans (age range: 18-85 years) who participated in the 2005 National Health Interview Survey (NHIS). The NHIS uses a multistage area probability design sampling of non-institutionalized representatives of the US civilian population. Of the sample, 85% were white and 56% were women.

Results: Univariate logistic regression analysis showed that individuals sleeping < 6 h were 3.55 times more likely than those sleeping 6-8 h to be functionally impaired (34% vs 13%; p < 0.001). Likewise, those sleeping > 8 h were 3.77 times more likely to be functionally impaired (36% vs 13%; p < 0.001). Individuals of the black race/ethnicity were more likely to be functionally impaired than their white counterparts (23% vs 19%; p < 0.001). Multivariate-adjusted regression analyses showed significant interactions between individuals' race/ethnicity and short sleep with respect to functional capacity (black: OR = 2.78, p < 0.0001; white: OR = 2.30, p < 0.0001). Significant interactions between race/ethnicity and long sleep were also observed (black: OR = 2.43, p < 0.001; white: OR = 2.63, p < 0.001).

Conclusion: Our findings suggest that individuals' habitual sleep duration and their race/ethnicity are significant predictors of their functional capacity.
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http://dx.doi.org/10.5664/jcsm.2762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659382PMC
June 2013

Beliefs and attitudes toward obstructive sleep apnea evaluation and treatment among blacks.

J Natl Med Assoc 2012 Nov-Dec;104(11-12):510-9

Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA.

Objective: Although blacks are at higher risk for obstructive sleep apnea (OSA), they are not as likely as their white counterparts to receive OSA evaluation and treatment. This study assessed knowledge, beliefs, and attitudes towards OSA evaluation and treatment among blacks residing in Brooklyn, New York.

Methods: Five focus groups involving 39 black men and women (aged > or =18 years) were conducted at State University of New York (SUNY) Downstate Medical Center in Brooklyn to ascertain barriers preventing or delaying OSA evaluation and treatment.

Results: Misconceptions about sleep apnea were a common theme that emerged from participants' responses. Obstructive sleep apnea was often viewed as a type of insomnia, an age-related phenomenon, and as being caused by certain bedtime activities. The major theme that emerged about barriers to OSA evaluation was unfamiliarity with the study environment. Barriers were categorized as: problems sleeping in a strange and unfamiliar environment, unfamiliarity with the study protocol, and fear of being watched while sleeping. Barriers to continuous positive airway pressure (CPAP) treatment adoption were related to the confining nature of the device, discomfort of wearing a mask while they slept, and concerns about their partner's perceptions of treatment.

Conclusion: Results of this study suggest potential avenues for interventions to increase adherence to recommended evaluation and treatment of OSA. Potential strategies include reducing misconceptions about OSA, increasing awareness of OSA in vulnerable communities, familiarizing patients and their partners with laboratory procedures used to diagnose and treat OSA. We propose that these strategies should be used to inform the development of culturally and linguistically tailored sleep apnea interventions to increase awareness of OSA among blacks who are at risk for OSA and associated comorbidities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740354PMC
http://dx.doi.org/10.1016/s0027-9684(15)30217-0DOI Listing
July 2013

Obstructive sleep apnea and cardiovascular disease in blacks: a call to action from the Association of Black Cardiologists.

Am Heart J 2013 Apr 19;165(4):468-76. Epub 2013 Feb 19.

Association of Black Cardiologists, Inc, Washington, DC, USA.

Obstructive sleep apnea (OSA) has emerged as a new and important risk factor for cardiovascular disease (CVD). Over the last decade, epidemiologic and clinical research has consistently supported the association of OSA with increased cardiovascular (CV) morbidity and mortality. Such evidence prompted the American Heart Association to issue a scientific statement describing the need to recognize OSA as an important target for therapy in reducing CV risk. Emerging facts suggest that marked racial differences exist in the association of OSA with CVD. Although both conditions are more prevalent in blacks, almost all National Institutes of Health-funded research projects evaluating the relationship between OSA and CV risk have been conducted in predominantly white populations. There is an urgent need for research studies investigating the CV impact of OSA among high-risk minorities, especially blacks. This article first examines the evidence supporting the association between OSA and CVD and reviews the influence of ethnic/racial differences on this association. Public health implications of OSA and future directions, especially regarding minority populations, are discussed.
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http://dx.doi.org/10.1016/j.ahj.2012.12.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144432PMC
April 2013

Nonischemic mitral regurgitation: prognostic value of nonsustained ventricular tachycardia after mitral valve surgery.

Cardiology 2013 20;124(2):108-15. Epub 2013 Feb 20.

Division of Cardiovascular Medicine, Department of Medicine, The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, NY, USA.

Background: Nonsustained ventricular tachycardia (VT), frequent in unoperated severe mitral regurgitation (MR), confers mortality risk [sudden death (SD) and cardiac death (CD)]. The prognostic value of VT after mitral valve surgery (MVS) is unknown; we aimed to define this prognostic value and to assess its modulation by left (LV) and/or right (RV) ventricular ejection fraction (EF) for mortality after MVS.

Methods: In 57 patients (53% females, aged 58 ± 12 years) with severe MR prospectively followed before and after MVS, we performed 24-hour ambulatory electrocardiograms approximately annually. LVEF and RVEF were determined within 1 year after MVS by radionuclide cineangiography.

Results: During 9.52 ± 3.49 endpoint-free follow-up years, late postoperative CD occurred in 11 patients (7 SD, 4 heart failures). In univariable analysis, >1 VT episode after MVS predicted SD (p < 0.01) and CD (SD or heart failure; p < 0.04). Subnormal postoperative RVEF predicted CD (p < 0.04). When adjusted for preoperative age, gender, etiology or antiarrhythmics, both postoperative VT and RVEF predicted CD (p ≤ 0.05). When postoperative VT and RVEF were both in the multivariable model, only subnormal RVEF predicted CD (p < 0.04). Among those with normal RVEF, VT >1 episode predicted SD (p = 0.03).

Conclusion: Postoperative VT and subnormal RVEF predict late postoperative deaths in nonischemic MR. Their assessment may aid patient management.
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http://dx.doi.org/10.1159/000347085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650723PMC
August 2013

Narrowed Aortoseptal Angle Is Related to Increased Central Blood Pressure and Aortic Pressure Wave Reflection.

Cardiorenal Med 2012 Aug 7;2(3):177-183. Epub 2012 Jun 7.

Division of Cardiovascular Medicine, Department of Medicine, Brooklyn, N.Y., USA.

The left ventricular (LV) aortoseptal angle (ASA) decreases with age, and is associated with basal septal hypertrophy (septal bulge). Enhanced arterial pressure wave reflection is known to impact LV hypertrophy. We assessed whether ASA is related to central blood pressure (BP) and augmentation index (AI), a measure of the reflected pressure wave. We studied 75 subjects (age 62 ± 16 years; 66% female) who were referred for transthoracic echocardiography and had radial artery applanation tonometry within 24 h. Peripheral systolic BP (P-SBP), peripheral diastolic BP (P-DBP), and peripheral pulse pressure (P-PP) were obtained by sphygmomanometry. Central BPs (C-SBP, C-DBP, C-PP) and AI were derived from applanation tonometry. AI was corrected for heart rate (AI75). The basal septal wall thickness (SWT), mid SWT and ASA were measured using the parasternal long axis echocardiographic view. Mean ASA and AI75 were 117 ± 11° and 22 ± 11%, respectively. ASA correlated with AI75 (r = -0.31, p ≤ 0.01), C-SBP (r = -0.24, p = 0.04), C-PP (r = -0.29, p = 0.01), but only showed a trend towards significance with P-SBP (r = -0.2, p = 0.09) and P-PP (r = -0.21, p = 0.08). Interestingly, C-PP was correlated with basal SWT (r = 0.27, p = 0.02) but not with mid SWT (r = 0.19, p = 0.11). On multivariate linear regression analysis, adjusted for age, gender, weight, and mean arterial pressure, AI75 was an independent predictor of ASA (p = 0.02). Our results suggest that a narrowed ASA is related to increased pressure wave reflection and higher central BP. Further studies are needed to determine whether narrowed LV ASA is a cause or consequence of enhanced wave reflection and whether other factors are involved.
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http://dx.doi.org/10.1159/000338827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433001PMC
August 2012

High Prevalence of Hypertension and Other Cardiometabolic Risk Factors in US- and Caribbean-Born Blacks with Chest Pain Syndromes.

Cardiorenal Med 2012 Aug;2(3):163-167

Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, N.Y., USA.

BACKGROUND: Caribbean-born blacks (CBB) have been reported to have lower coronary artery disease mortality rates than US-born blacks (UBB). We assessed whether CBB have a lower prevalence of cardiometabolic risk factors compared to UBB. METHODS: Non-Hispanic blacks (n = 275) hospitalized for chest pain who were prospectively enrolled in our Cardiovascular Outcomes Research Group (CORG) study provided clinical and demographic data. RESULTS: The study cohort comprised 45% (n = 125) UBB with a mean age of 61 ± 16 years and 55% (n = 150) CBB with a mean age of 63 ± 11 years. Myocardial infarction was diagnosed in 33% of UBB and 36% of CBB. CBB had a lower rate of previous myocardial infarction (14 vs. 24%; p = 0.04). They also smoked less (16 vs. 35%; p = 0.001) and were less likely to have first-degree relatives with coronary artery disease (24 vs. 41%; p = 0.018). However, they had a similarly high prevalence of hypertension (99 vs. 98%; p = 0.99), diabetes (58 vs. 48%; p = 0.11), dyslipidemia (53 vs. 42%; p = 0.08), and obesity (34 vs. 40%; p = 0.29) as UBB. CONCLUSION: A very high prevalence of hypertension exists in non-Hispanic blacks hospitalized for chest pain. CBB and UBB have a similar prevalence of cardiometabolic profile in our study population. Besides smoking, other factors contributing to lower CHD mortality reported for CBB need to be further explored.
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http://dx.doi.org/10.1159/000337716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428709PMC
August 2012

Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism.

Sleep Breath 2014 Mar 18;18(1):13-8. Epub 2012 Aug 18.

Department of Medicine, SUNY Downstate Medical Center (Box 1199), Brooklyn Health Disparities Center, 450 Clarkson Avenue, Brooklyn, NY, 11203-2098, USA.

Introduction: Over the past half century, evidence has been accumulating on the emergence of obstructive sleep apnea (OSA), the most prevalent sleep-disordered breathing, as a major risk factor for cardiovascular disease. A significant body of research has been focused on elucidating the complex interplay between OSA and cardiovascular risk factors, including dyslipidemia, obesity, hypertension, and diabetes mellitus that portend increased morbidity and mortality in susceptible individuals.

Conclusion: Although a clear causal relationship of OSA and dyslipidemia is yet to be demonstrated, there is increasing evidence that chronic intermittent hypoxia, a major component of OSA, is independently associated and possibly the root cause of the dyslipidemia via the generation of stearoyl-coenzyme A desaturase-1 and reactive oxygen species, peroxidation of lipids, and sympathetic system dysfunction. The aim of this review is to highlight the relationship between OSA and dyslipidemia in the development of atherosclerosis and present the pathophysiologic mechanisms linking its association to clinical disease. Issues relating to epidemiology, confounding factors, significant gaps in research and future directions are also discussed.
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http://dx.doi.org/10.1007/s11325-012-0760-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805366PMC
March 2014

Functional capacity is a better predictor of coronary heart disease than depression or abnormal sleep duration in Black and White Americans.

Sleep Med 2012 Jun 31;13(6):728-31. Epub 2012 Mar 31.

Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA.

Objective: To assess whether functional capacity is a better predictor of coronary heart disease (CHD) than depression or abnormal sleep duration.

Methods: Adult civilians in the USA (n=29,818, mean age 48 ± 18 years, range 18-85 years) were recruited by a cross-sectional household interview survey using multistage area probability sampling. Data on chronic conditions, estimated habitual sleep duration, functional capacity, depressed moods, and sociodemographic characteristics were obtained.

Results: Thirty-five percent of participants reported reduced functional capacity. The CHD rates among White and Black Americans were 5.2% and 4%, respectively. Individuals with CHD were more likely to report extreme sleep durations (short sleep [≤ 5h] or long sleep [≥ 9 h]; odds ratio [OR] 1.65, 95% confidence interval [CI] 1.38-1.97; P<0.0001), less likely to be functionally active (anchored by the ability to walk one-quarter of a mile without assistance [OR 6.27, 95% CI 5.64-6.98; P<0.0001]) and more likely to be depressed (OR 1.78, 95% CI 1.60-1.99; P<0.0001) than their counterparts. On multivariate regression analysis adjusting for sociodemographic factors and health characteristics, only functional capacity remained an independent predictor of CHD (OR 1.81, 95% CI 1.42-2.31; P<0.0001).

Conclusion: Functional capacity was an independent predictor of CHD in the study population, whereas depression and sleep duration were not independent predictors.
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http://dx.doi.org/10.1016/j.sleep.2012.01.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372763PMC
June 2012

Management of Hypertension among Patients with Coronary Heart Disease.

Int J Hypertens 2011 13;2011:653903. Epub 2011 Jul 13.

Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.

Evidence suggests that coronary heart disease (CHD) is the most common outcome of hypertension. Hypertension accelerates the development of atherosclerosis, and sustained elevation of blood pressure (BP) can destabilize vascular lesions and precipitate acute coronary events. Hypertension can cause myocardial ischemia in the absence of CHD. These cardiovascular risks attributed to hypertension can be reduced by optimal BP control. Although several antihypertensive agents exist, the choice of agent and the appropriate target BP for patients with CHD remain controversial. In this succinct paper, we examine the evidence and the mechanisms for the linkage between hypertension and CHD and we discuss the treatment options and the goals of therapy that are consistent with the report of the seventh Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and American Heart Association scientific statement. We anticipate changes in the recommendations of the forthcoming JNC 8.
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http://dx.doi.org/10.4061/2011/653903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139133PMC
November 2011

Resolution of dialyzer membrane-associated thrombocytopenia with use of cellulose triacetate membrane: a case report.

Case Rep Med 2011 10;2011:134295. Epub 2011 Apr 10.

Department of Family Medicine, State University of New York Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA.

Blood and dialyzer membrane interaction can cause significant thrombocytopenia through the activation of complement system. The extent of this interaction determines the biocompatibility of the membrane. Although the newer synthetic membranes have been shown to have better biocompatibility profile than the cellulose-based membranes, little is known about the difference in biocompatibility between synthetic membrane and modified cellulose membrane. Herein, we report a case of a patient on hemodialysis who developed dialyzer-membrane-related thrombocytopenia with use of synthetic membrane (F200NR polysulfone). The diagnosis of dialyzer membrane-associated thrombocytopenia was suspected by the trend of platelet count before and after dialysis, and the absence of other possible causes of thrombocytopenia. We observed significant improvement in platelet count when the membrane was changed to modified cellulose membrane (cellulose triacetate). In patients at high risk for thrombocytopenia, the modified cellulose membrane could be a better alternative to the standard synthetic membranes during hemodialysis.
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http://dx.doi.org/10.1155/2011/134295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085822PMC
July 2011

Harmonic analysis of noninvasively recorded arterial pressure waveforms in healthy bonnet macaques (Macaca radiata).

J Am Assoc Lab Anim Sci 2011 Jan;50(1):79-83

Division of Cardiovascular Medicine, Department of Psychiatry, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.

To characterize primate arterial waveforms, we prospectively studied 38 bonnet macaques (Macaca radiata; 25 female, 13 ± 4 y). Brachial artery waveforms were recorded from these animals by applanation tonometry and were decomposed into harmonics by using Fourier analysis. The ratio of individual to total harmonic amplitude (H:T) was derived from frequency spectra. Left ventricular (LV) mass, ejection fraction, fractional shortening, septal wall thickness, posterior wall thickness, LV end-diastolic diameter, and LV end-systolic diameter were obtained by echocardiography in all 38 monkeys. Blood pressure was obtained by sphygmomanometry. The fundamental frequency was 2.76 cycles/s. Harmonics ranged from 5 to 14. Indexed LV mass was inversely correlated with third H:T and second H:T but not with systolic or diastolic blood pressure. In addition, the third H:T was inversely correlated with septal wall thickness, posterior wall thickness, and LV end-diastolic diameter, whereas second H:T was inversely correlated with LV end-diastolic diameter. Heart rate was inversely correlated with eighth H:T. On multivariate analysis adjusting for age, gender, weight, and length, only third H:T was an independent predictor of LV mass. Harmonic analysis of arterial waveforms may provide information pertaining to LV mass. Lower H:T ratios (second and third) are related to LV mass, whereas higher H:T (eighth) is related to heart rate.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035408PMC
January 2011
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