scholarly journals Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Care Coordination Program

2021 ◽  
Author(s):  
Sonal J. Patil ◽  
Mojgan Golzy ◽  
Angela Johnson ◽  
Yan Wang ◽  
Jerry C Parker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Disease Management ◽  
Systolic Blood Pressure ◽  
Care Coordination ◽  
Ldl Cholesterol ◽  
Management Support ◽  
Post Intervention ◽  
Factors Associated ◽  
Main Effect ◽  
Neighborhood Level

Abstract Background: Identifying clinical, sociodemographic, and neighborhood-level risk factors associated with less improvement or worsening cardiometabolic measures despite access to a clinic-based care coordination program may help identify candidates that need additional disease management support outside clinic walls. Methods: Secondary data analysis of data from care coordination program cohort, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2). Setting/Participants: Medicare, Medicaid, dual-eligible adults from ten Midwestern primary care clinics in the US. Intervention: Two-year nurse-led care coordination program. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed each patient's clinical, sociodemographic, and neighborhood-level factors associated with change in outcome measures from before to after completion of LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure (61.6% women, 86.3% White, non-Hispanic ethnicity, mean age 62.7 [SD, 18.5] years). In adjusted models, higher pre-intervention measures were associated with worsening of all cardiometabolic measures (LDL-cholesterol β 0.56, 95% CI 0.52 to 0.60, p < 0.001; HbA1C β 0.51, 95% CI 0.43 to 0.59, p < 0.001; Systolic blood pressure β 0.95, 95% CI 0.83 to 1.08, p < 0.001). Women had worsening LDL- cholesterol compared to men (β 7.76, 95% CI 5.21 to 10.32, p <0.001). Women with pre-intervention HbA1C > 6.8% and systolic blood pressure >131 mm of Hg had worse post-intervention HbA1C (main effect β -1.29, 95% CI -1.95 to -0.62, p < 0.001; interaction effect β 0.19, 95% CI 0.09 to 0.28, p < 0.001), and systolic blood pressure (main effect β -7.86, 95% CI -15.55 to -0.17 p = 0.04; interaction effect β 0.06, 95% CI 0.002 to 0.12, p = 0.043) compared to men. Adding individual’s neighborhood-level risks or sensitivity analysis for clustering by clinics and census tracts did not change effect sizes significantly.Conclusions: Higher baseline cardiometabolic measures and women with high baseline cardiometabolic measures (compared to men) were associated with worsening of cardiometabolic outcomes in participants of a solely clinic-based care coordination program. Understanding the contextual causes for these associations may aid in tailoring disease management support outside clinic walls.

scholarly journals Individual-level and neighborhood-level factors associated with longitudinal changes in cardiometabolic measures in participants of a care coordination program

2021 ◽  
Author(s):  
Sonal J Patil ◽  
Mojgan Golzy ◽  
Angela Johnson ◽  
Yan Wang ◽  
Jerry C Parker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Care Coordination ◽  
Hemoglobin A1c ◽  
Ldl Cholesterol ◽  
Female Gender ◽  
Primary Care Clinics ◽  
Driving Time ◽  
Main Effect ◽  
Neighborhood Level

AbstractIntroductionIdentifying individual and neighborhood-level factors associated with less improvement or worsening cardiometabolic measures in participants of clinic-based interventions may help identify candidates for supplementary community-based interventions.MethodsStudy design: Secondary data analysis of data from care coordination program cohort, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2). Participants: Medicare, Medicaid, or dual-eligible adults from the University of Missouri Health System enrolled in LIGHT2. Intervention: Nurse-led care coordination in ten primary care clinics. Outcomes: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed changes in outcomes after adjusting for clinical and sociodemographic factors, neighborhood-level factors, and driving time to primary care clinics.Results6378 participants had pre-and post-intervention cardiometabolic measures reported (61% women, 86.3% White, non-Hispanic ethnicity, mean age 62.7 [SD, 18.5] years). In adjusted models, pre-intervention measures and female gender were associated with worsening of all cardiometabolic measures. Women’s LDL-cholesterol worsened compared to men irrespective of pre-intervention levels (β 7.87, 95% CI 5.24 to 10.5, p<.001). Women with hemoglobin A1C> 6.8% had worsening hemoglobin A1C compared to men (main effect β −1.28, 95% CI −1.95 to −0.61, p<.001; interaction effect β 0.19, 95% CI 0.09 to 0.28, p<.001). Women with systolic blood pressure >121 mm of Hg had worsening diastolic blood pressure compared to men (main effect β −5.42, 95% CI −9.8 to 0.098, p = 0.016; interaction effect β 0.04, 95% CI 0.01 to 0.078, p = 0.009). Adding neighborhood-level factors or driving time to primary care clinics did not improve the overall fit of the models.ConclusionsIn a solely clinic-based care coordination program, increasing baseline cardiometabolic measures and female gender were associated with worsening cardiometabolic outcomes. Further research to understand the causes of these associations may help tailor clinic-community-linked interventions.

scholarly journals Evaluation of Clinical Variables Associated with Increased Carotid Intima-Media Thickness in Middle-Aged Hypertensive Women

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Michelle Trindade ◽  
Renata Brum Martucci ◽  
Adriana K. Burlá ◽  
Wille Oigman ◽  
Mario Fritsch Neves ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pulse Pressure ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Independent Variables ◽  
Vascular Ultrasound ◽  
Media Thickness

It has been previously documented that carotid intima-media thickness (cIMT) is a predictor of cardiovascular disease. The aim of this study was to identify clinical parameters associated with an increased cIMT treated hypertensive women. Female patients (n=116) with essential hypertension, aged 40–65 years, were included in this study. Vascular ultrasound was performed and the patients were divided into two groups according to the values of cIMT (< or ≥0.9 mm). Patients with greater cIMT presented significantly higher systolic blood pressure and pulse pressure. Serum HDL-cholesterol was significantly lower and CRP was significantly higher in the same group. There was a significant correlation between cIMT and age (r=0.25,P=0.007), systolic blood pressure (r=0.19,P=0.009), pulse pressure (r=0.30,P=0.001), and LDL-cholesterol (r=0.19,P=0.043). cIMT was correlated to CRP (r=0.31,P=0.007) and negatively correlated to HDL-cholesterol (r=0.33,P=0.001). In logistic regression, only HDL-cholesterol, CRP, and pulse pressure were shown to be independent variables associated to increased cIMT. In conclusion, pulse pressure, HDL-cholesterol, and CRP are variables correlated with cIMT in treated hypertensive women.

Abstract P011: Cardiovascular Risk Factors and Longevity

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Michelle C Odden ◽  
Andreea Rawlings ◽  
Alice Arnold ◽  
Mary Cushman ◽  
Mary Lou Biggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Old Age ◽  
Repeated Measures ◽  
Ldl Cholesterol ◽  
Low Cardiovascular Risk

Introduction: Cardiovascular disease is the leading cause of mortality in old age, yet there is limited research on the patterns of cardiovascular risk factors that predict survival to 90 years. Hypothesis: The patterns of cardiovascular risk factors that portend longevity will differ from those that confer low cardiovascular risk. Methods: We examined repeated measures of blood pressure, LDL-cholesterol, and BMI from age 67 and survival to 90 years in the Cardiovascular Health Study (CHS). CHS is a prospective study of 5,888 black and white adults in two waves (1989-90 and 1992-93) from Medicare eligibility lists in four counties in the U.S. We restricted to participants aged 67 to 75 years at baseline to control for birth cohort effects and examined repeated measures of cardiovascular risk factors throughout the late-life course. We fit logistic regression models to predict survival to age 90 using generalized estimating equations, and modeled the risk factors as linear, a linear spline, and clinically relevant categories. Models were adjusted for demographics and medication use, and we also examined whether the association of each risk factor with longevity varied by the age of risk factor measurement. Best fit models are presented. Results: Among 3,645 participants in the birth cohort, 1,160 (31.8%) survived to 90 by June 16 th , 2015. Higher systolic blood pressure in early old age was associated with reduced odds for longevity, but there was an interaction with age such that the association crossed the null at 80 years. (Table) Among those with LDL-cholesterol <130 mg/dL, higher LDL-cholesterol was associated with greater longevity; at levels above 130 mg/dL there was no association between LDL-cholesterol and longevity. BMI had a u-shaped association with longevity. Conclusions: In summary, the patterns of risk factors that predict longevity differ from that considered to predict low cardiovascular risk. The risk of high systolic blood pressure appears to depend on the age of blood pressure measurement.

Factors Associated With Intradialytic Systolic Blood Pressure Variability

2012 ◽  
Vol 59 (3) ◽  
pp. 409-418 ◽  
Author(s):  
Jennifer E. Flythe ◽  
Srikanth Kunaparaju ◽  
Kumar Dinesh ◽  
Kathryn Cape ◽  
Harold I. Feldman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Factors Associated ◽  
Systolic Blood Pressure Variability

A Model of Systolic Blood Pressure During the Course of Dialysis and Clinical Factors Associated With Various Blood Pressure Behaviors

2011 ◽  
Vol 58 (5) ◽  
pp. 794-803 ◽  
Author(s):  
Kumar Dinesh ◽  
Srikanth Kunaparaju ◽  
Kathryn Cape ◽  
Jennifer E. Flythe ◽  
Harold I. Feldman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Clinical Factors ◽  
Factors Associated

scholarly journals Indoor Cooking Practices and Associated Health Factors Among Participants in the Dominican Republic and Nicaragua: A Collaborative Study Between Respiratory Therapy Students and Comunidad Connect

2021 ◽  
Author(s):  
Rachel Culbreth ◽  
Rachel Trawick ◽  
Jon Thompson ◽  
Douglas Gardenhire
Keyword(s):  
Blood Pressure ◽  
Carbon Monoxide ◽  
Dominican Republic ◽  
Systolic Blood Pressure ◽  
Collaborative Study ◽  
Vital Signs ◽  
Flow Measurements ◽  
Middle Income ◽  
Factors Associated ◽  
Cooking Practices

The purpose of this study is to determine factors associated with indoor cooking practices and specific vital signs across two middle-income countries, Dominican Republic and Nicaragua. This study used data from Nicaragua (n=76) and Dominican Republic (n=62) (collected in 2018-2019). Multivariable linear regression was utilized to determine factors associated with carbon monoxide levels and systolic blood pressure. Among all participants (n=138), approximately half lived in Nicaragua (n=76, 55.1%) and half lived in Dominican Republic (n=62, 44.9%). The overall smoking prevalence in each country was low (9.2% in Nicaragua and 4.8% in Dominican Republic). Age was associated with higher carbon monoxide levels and higher systolic blood pressure measurements in each country. Future studies should examine a broader range of contextual and behavioral factors related to carbon monoxide and peak flow measurements in the two countries.

scholarly journals Progression of Chronic Kidney Disease in Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1323-1323
Author(s):  
Emily Ciccone ◽  
R. Rosina Kilgore ◽  
Qingning Zhou ◽  
Jianwen Cai ◽  
Vimal K. Derebail ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Sickle Cell ◽  
Acute Chest Syndrome ◽  
Factors Associated ◽  
History Of ◽  
Dipstick Urinalysis ◽  
Rate Of Decline

Abstract Introduction: Chronic kidney disease (CKD) is common in patients with sickle cell disease (SCD). Despite current practice and recent NHLBI guidelines, which recommend screening and treatment for albuminuria, the progression of CKD in SCD and factors associated with such progression remain poorly defined. The purpose of this study was to evaluate the prevalence of CKD and its rate of progression in adult SCD patients. We also evaluated the laboratory and clinical factors associated with CKD progression. Methods: We conducted a retrospective study of patients seen between July 2004 and December 2013 at an adult Sickle Cell Clinic. Patients had confirmed diagnoses of SCD, were at least 18 years old, and were in the non-crisis state at the time of evaluation. Patients were excluded for histories of HIV, hepatitis B and C, and systemic lupuserythematosus. Clinical and laboratory variables were obtained from medical records. Estimated glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation.Presence of CKD was assessed by using a modification of the Kidney Disease Improving Global Outcomes clinical practice guidelines that incorporateseGFR and levels of albuminuria. CKD was defined aseGFR<90 or presence of proteinuria (at least 1+ on dipstick urinalysis). A linear mixed effects model was used to analyze the rate ofeGFR decline with a random intercept and fixed time effect for each subject. Linear mixed effect models were also used to identify risk factors for decline ofeGFR - one utilizing laboratory values and the other utilizing demographic and clinical characteristics. Results: Four hundred and twenty six patients with SCD (SS = 268, SC = 98, Sb0 = 22, Sb+ = 29, SE = 3, SD = 2, SHPFH = 4), median age of 29.5 years (IQR: 20 - 41 years), were evaluated. CKD at baseline was observed in 92 patients (21.6 %). The rate of decline in eGFR over time was 2.1 mL/min per 1.73 m2 per year (SE: 0.11, p < 0.0001) (Figure 1). Baseline laboratory factors that were significantly associated with decline ineGFR inunivariate analyses were hemoglobin, lactate dehydrogenase, indirect bilirubin, ferritin, hematuria, urine specific gravity, and proteinuria (at least 1+ on dipstick urinalysis). Clinical variables significantly associated witheGFR decline inunivariate analyses were weight, history of acute chest syndrome,history of stroke, chronic transfusion, systolic blood pressure, diastolic blood pressure, and use of ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB). Multivariable analyses showed that the rate ofeGFR decline was dependent on the status of having proteinuria (estimate: -3.96, p < 0.0001), age (estimate: -0.05, p<0.0001), weight (estimate: 0.025, p<0.0001), systolic blood pressure (estimate: -0.033, p<0.0001), stroke (estimate: -1.84, p<0.0001), acute chest syndrome (estimate: -0.93, p=0.006), and chronic transfusions (estimate: 3.60, p=0.0002) (Table 1). Conclusion: eGFR declined at a rate of 2.1 mL/min per 1.73 m2 per year in adult patients with SCD. Proteinuria, age, acute chest syndrome, stroke, and higher systolic blood pressure were associated with an increased rate of decline in eGFR. However, heavier weight and chronic red cell transfusions were associated with less severe eGFR decline. Better understanding of these relationships and their pathophysiology is needed so that we can modify identified risk factors and attenuate the loss of kidney function in SCD. Disclosures No relevant conflicts of interest to declare.

scholarly journals Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250757
Author(s):  
Kenichi Sakakura ◽  
Yousuke Taniguchi ◽  
Kei Yamamoto ◽  
Takunori Tsukui ◽  
Hiroyuki Jinnouchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Beta Blockers ◽  
Multivariate Logistic Regression Analysis ◽  
Rotational Atherectomy ◽  
Lesion Length ◽  
Slow Flow ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Flow Group

Background Although several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow. Methods We included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow. Results Slow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205–0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097–0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271–0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297–0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093–1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171–3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130–3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212–1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004–3.573, p = 0.049) were significantly associated with slow flow. Conclusions Slow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.

scholarly journals Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: the Tromsø Study 2015–2016

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001777
Author(s):  
Amalie Nilsen ◽  
Tove Aminda Hanssen ◽  
Knut Tore Lappegård ◽  
Anne Elise Eggen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Systolic Blood Pressure ◽  
Total Cholesterol ◽  
Diastolic Blood Pressure ◽  
Ldl Cholesterol ◽  
National Guidelines ◽  
Population Proportion ◽  
Total Proportion

AimsTo compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017.MethodsWe included participants from the Norwegian population-based Tromsø Study (2015–2016) aged 40–69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg).ResultsThe total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk.ConclusionThe population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.

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