Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
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Query Trace: Keenan NL[original query] |
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Screening for lipid disorders among adults--National Health and Nutrition Examination Survey, United States, 2005-2008
Gillespie CD , Keenan NL , Miner JB , Hong Y . MMWR Suppl 2012 61 (2) 26-31 Cardiovascular disease (CVD) is the leading cause of preventable death in the United States, a major contributor to adult disability, and one of the most expensive conditions treated in U.S. hospitals. Lipid disorders (e.g., high blood cholesterol and triglycerides) increase the risk for atherosclerosis, which can lead to coronary heart disease (CHD), which accounts for a substantial proportion of cardiovascular mortality. Screening for lipid abnormalities is essential in detecting and properly managing lipid disorders early in the atherogenic process, thereby preventing the development of atherosclerotic plaques and minimizing existing plaques. Based on evidence-based studies, the United States Preventive Services Task Force (USPSTF) concluded that lipid measurement can identify asymptomatic adults who are eligible for cholesterol-lowering therapy. |
Sodium consumption among hypertensive adults advised to reduce their intake: National Health and Nutrition Examination Survey, 1999-2004
Ayala C , Gillespie C , Cogswell M , Keenan NL , Merritt R . J Clin Hypertens (Greenwich) 2012 14 (7) 447-54 The authors estimated the prevalence of taking action to reduce intake related to actual sodium consumption among 2970 nonpregnant US adults 18 years and older with self-reported hypertension by using data from the National Health and Nutrition Examination Survey 1999-2004. Adjusted multiple linear regression assessed differences in mean sodium intake by action status. A total of 60.5% of hypertensive adults received advice to reduce sodium intake. Of this group, 83.7% took action to reduce sodium. Action to reduce sodium intake differed significantly by age, race/ethnicity, and use of an antihypertensive. The mean (+/-standard error) sodium intake among hypertensive adults was 3341+/-37 mg and differed by sex, age, race/ethnicity, education, and body mass index (P<.05), with the lowest intake among adults aged 65 years and older (2780+/-48 mg). Mean intake did not differ significantly by action status either overall or by subgroup except for one age category: among patients 65 years and older, mean intake was significantly lower among those who took action (2715+/-63 mg) than among those who did not (3401+/-206 mg; P=.0124). Regardless of action, mean intake was well above 1999-2004 recommendations for daily sodium intake and about twice as high as the current recommendation for hypertensive adults (1500 mg). (J Clin Hypertens (Greenwich). 2012; 14:447-454. (c)2012 Wiley Periodicals, Inc.) |
Public health options for improving cardiovascular health among older Americans
Greenlund KJ , Keenan NL , Clayton PF , Pandey DK , Hong Y . Am J Public Health 2012 102 (8) 1498-507 Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e10. doi:10.2105/AJPH.2011.300570). |
Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010
Kulshreshtha A , Anderson LM , Goyal A , Keenan NL . Neuroepidemiology 2012 38 (3) 123-9 BACKGROUND: Globally 15 million people have an acute stroke every year and one third of them die secondary to stroke events. Most research on stroke prevention and treatment is done in developed countries, yet more than 85% of strokes occur in developing countries. In particular, stroke remains an underrecognized cause of death and disability in South Asia. METHODS: We conducted a systematic review to identify reliable and comparable epidemiological evidence on stroke in South Asia from 1980 to 2010. Publications were screened for eligibility to identify only population-based stroke studies. RESULTS: Of the 71 studies retrieved, only 6 studies from South Asia gave us acceptable estimates of the burden of stroke. Population-based studies from South Asia have stroke prevalence in the range of 45-471 per 100,000. The age-adjusted incidence rate varied from approximately 145 per 100,000 to 262 per 100,000. Rural parts of South Asia have a lower stroke prevalence compared with urban areas. CONCLUSIONS: Our review highlights the paucity of research data in South Asia. This must be addressed in order to accurately determine the burden of stroke in South Asia, so that specific policy recommendations can be formulated to combat the stroke epidemic in this region. |
Association of sleep duration and hypertension among US adults varies by age and sex
Fang J , Wheaton AG , Keenan NL , Greenlund KJ , Perry GS , Croft JB . Am J Hypertens 2012 25 (3) 335-41 BACKGROUND: While short sleep duration has been related to hypertension, the impact of age and sex on this association is less well known. We examined the association between hours of sleep and hypertension prevalence among US adults by age and sex. METHODS: The study was conducted using data from the 2007-2009 National Health Interview Surveys (NHISs). The association between self-reported hours of sleep and prevalence of hypertension was assessed after stratifying by age and sex. RESULTS: Among 71,455 participants, age-standardized hypertension prevalence rates (%) were 32.4, 25.5, 22.2, 23.2, 25.5, and 32.5 among adults reporting sleep of <6, 6, 7, 8, 9, and ≥10 h/day, respectively (P < 0.001). There was a "U"-shaped association of hours of sleep and hypertension prevalence among all age and sex subgroups. Logistic regression models, using 8 h sleep/day as the referent, showed a greater likelihood of hypertension among those who slept <7 or ≥10 h/day after adjusting for sociodemographic, behavior, and health characteristics. Further stratifying by age and sex, while adjusting for all other characteristics, revealed that among adults less than 45 years, short (<6 h for men and <8 h for women) and long (≥10 h for men) sleep were associated with higher likelihood of hypertension. For other age/sex groups, short sleep (<6 h) was associated with higher likelihood of hypertension among middle-aged men and older women, as was long sleep (≥10 h) among middle-aged women. CONCLUSIONS: This national sample study suggests that the association between hours of sleep and hypertension varies by age and sex. (American Journal of Hypertension (2012); doi:10.1038/ajh.2011.201.) |
Regular use of a home blood pressure monitor by hypertensive adults - HealthStyles, 2005 and 2008
Ayala C , Tong X , Keenan NL . J Clin Hypertens (Greenwich) 2012 14 (3) 172-7 The authors analyzed HealthStyles surveys 2005 and 2008 combined to assess the prevalence of regular home blood pressure monitor (HBPM) use among hypertensive adults. All data were self-reported. The authors calculated odds ratios (ORs) of regular HBPM use and relative percent change (RPC) in the use of HBPM between the 2 survey years. There were 3739 (32.6%) hypertensives in the 2 survey years combined. Based on the self-reported data, the proportion of hypertensives who regularly used an HBPM was 43.2%. Male sex, age, race/ethnicity, household income, and education were all associated with differences in the prevalence of regular HBPM use. Patients 65 years and older (OR, 2.38; 95% confidence interval [CI], 1.49-3.81) were significantly more likely to be regular HBPM users than those 18 to 34 years. Non-Hispanic blacks were significantly less likely (OR, 0.69; 95% CI, 0.55-0.86) to be regular HBPM users than non-Hispanic whites. From 2005 to 2008, the RPC in regular HBPM use was 14.2% (from 40.1% to 45.8%); the largest RPCs were for the 3 youngest age groups, men, non-Hispanic blacks, and those with a household income of $40,000 to 59,900. Because HBPM has been demonstrated to aid in hypertension control, health care professionals should promote its use especially among hypertensives who are younger, non-Hispanic blacks, Hispanics, or with a lower income. |
Primary health care providers' attitudes and counseling behaviors related to dietary sodium reduction
Fang J , Cogswell ME , Keenan NL , Merritt RK . Arch Intern Med 2012 172 (1) 76-8 High sodium intake is associated with increased blood pressure.1 Average sodium intake among US adults far exceeds recommendations.2 Primary care physicians and nurse practitioners are the first line of medical care and can influence opinions and behaviors of their patients.3,4 Although some information exists about perceived advice from health professionals related to sodium reduction,5 little is known about health care providers’ own perceptions about sodium intake and patient counseling behaviors about reducing sodium intake. We used data from DocStyles, aWeb-based survey of health care providers. Participants included health care providers who practiced in the United States; worked in an individual, group, or hospital setting; and had practiced medicine for a minimum of 3 years. In 2010, family/general practitioners (FGPs), internists, and nurse practitioners were asked questions on sodium. Response rates were 45.2% for FGPs and internists combined and 52.6% for nurse practitioners. | The sodium intake component of this survey consisted of 6 questions assessing health care providers’ opinions and perceived counseling behaviors related to reducing dietary sodium intake. The survey also included questions about health care provider characteristics, including sociodemographic (age, sex, and race/ethnicity), medical practice (type of practitioner, practice setting, years of practice, whether they practice at a teaching hospital, and the financial situation of the majority of their patients), and health-related behavior (self- reported height and weight; the number of days per week they eat at least 5 cups of fruit or vegetables; smoke cigarettes, cigars, or pipes; and exercise or keep their heart rate up for at least 30 min/d). |
Prevalence of hypertension and controlled hypertension - United States, 2005-2008
Keenan NL , Rosendorf KA . MMWR Suppl 2011 60 (1) 94-7 Hypertension is a serious public health challenge in the United States, affecting approximately 30% of adults (1,2) and increasing the risk for heart disease and stroke, the first and third leading causes of death in the United States* (3). Racial/ethnic and socioeconomic disparities in hypertension prevalence in the United States have been documented for decades (4). Non-Hispanic blacks have a higher risk for hypertension and hypertension-related complications (e.g., stroke, diabetes, and chronic kidney disease) than non-Hispanic whites and Mexican Americans (2,4). Between 1999--2000 and 2007--2008, the prevalence of hypertension did not change, but control of hypertension increased among those with hypertension (1,5). Despite considerable improvements in increasing awareness, treatment and control of hypertension, in 2007--2008, approximately half of adults with hypertension did not have their blood pressure under control (1). Because of the fundamental role of hypertension in cardiovascular health, Healthy People 2010 includes national objectives to reduce the proportion of adults aged ≥20 years with hypertension to 14% from a baseline of 26% (objective 12-9) and to increase the proportion of adults aged ≥18 years with hypertension whose blood pressure is under control to 68% from a baseline of 25% (objective 12-10) (6,7). | | To estimate age-adjusted hypertension prevalence and control among persons aged ≥18 years, CDC analyzed combined National Health and Nutrition Examination Survey (NHANES) data from two survey periods: 2005--2006 and 2007--2008.† NHANES is a nationally representative survey of the noninstitutionalized U.S. civilian population. Data are collected annually but released in 2-year cycles. NHANES includes a home interview and a physical examination at a mobile examination center where blood pressure is measured. Participants were selected through a complex, multistage sampling probability design. During 2005--2008, the response rate among persons in the sample was 76.4%.§ Data were analyzed for 10,488 participants for whom adequate interview and examination data were collected to determine hypertension status. |
Coronary heart disease and stroke deaths - United States, 2006
Keenan NL , Shaw KM . MMWR Suppl 2011 60 (1) 62-6 Heart disease and stroke are the first and third leading causes of death in the United States* (1) and have maintained this ranking since 1921 and 1938, respectively (2). In 2006, cardiovascular disease was responsible for 31.7% of all deaths: 26.0% from heart disease and 5.7% from stroke (1). Deaths from coronary heart disease (CHD) (425,425 deaths) comprise 67.4% of all deaths from heart disease (631,636 deaths). The Healthy People 2010 objectives of reducing death rates to 162 deaths per 100,000 population for CHD and 50 deaths per 100,000 for stroke (objectives 12-1 and 12-7) were met in 2004 (3). However, despite the overall decrease in CHD and stroke death rates, the target death rates for both diseases were not met for two subpopulations: blacks and men. | | Healthy People 2020 has four overarching goals: 1) eliminate preventable disease, disability, injury, and premature death; 2) achieve health equity, eliminate disparities, and improve the health of all groups; 3) create social and physical environments that promote good health for all; and 4) promote healthy development and healthy behaviors across every life stage (4). Examining and monitoring the distribution of death rates provides the requisite information for focusing on the groups most in need of early intervention to eliminate preventable disease, disability, and premature death and to improve the health of all groups. |
Risk of cardiovascular mortality in relation to optimal low-density lipoprotein cholesterol combined with hypertriglyceridemia: is there a difference by gender?
Kuklina EV , Keenan NL , Callaghan WM , Hong Y . Ann Epidemiol 2011 21 (11) 807-14 PURPOSE: The objectives of the present study were to determine whether an optimal low-density lipoprotein cholesterol (LDL-C) combined with hypertriglyceridemia was associated with cardiovascular disease (CVD) mortality and whether these associations differ by gender. METHODS: A cohort of 2903 U.S. adults aged ≥45 years (men) and ≥55 years (women) at baseline (1988-1994) was followed through December 2006 for CVD mortality. Baseline data were collected through the Third National Health and Nutrition Examination Survey (NHANES III). The definitions of high LDL-C and high triglycerides (TG) (hypertriglyceridemia) levels were based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of death. RESULTS: After adjusting for age, race/ethnicity, and traditional CVD risk factors, the risk of CVD death was approximately two times as high among women with optimal LDL-C/hypertriglyceridemia (2.42, 95% CI = 1.35-4.33) compared to women with optimal LDL-C/normal TG. In contrast, no significant difference was found among men on this comparison. CONCLUSIONS: Judging from this study, hypertriglyceridemia is associated with an increased risk of CVD mortality in women but not in men. The association is independent of abnormal LDL-C effect. |
Racial/Ethnic and socioeconomic disparities in health-related quality of life among people with coronary heart disease, 2007
Hayes DK , Greenlund KJ , Denny CH , Neyer JR , Croft JB , Keenan NL . Prev Chronic Dis 2011 8 (4) A78 INTRODUCTION: Health-related quality of life (HRQOL) refers to a person's or group's perceived physical and mental health over time. Coronary heart disease (CHD) affects HRQOL and likely varies among groups. This study examined disparities in HRQOL among adults with self-reported CHD. METHODS: We examined disparities in HRQOL by using the unhealthy days measurements among adults who self-reported CHD in the 2007 Behavioral Risk Factor Surveillance System state-based telephone survey. CHD was based on self-reported medical history of heart attack, angina, or coronary heart disease. We assessed differences in fair/poor health status, 14 or more physically unhealthy days, 14 or more mentally unhealthy days, 14 or more total unhealthy days (total of physically and mentally unhealthy days), and 14 or more activity-limited days. Multivariate logistic regression models included age, race/ethnicity, sex, education, annual household income, household size, and health insurance coverage. RESULTS: Of the population surveyed, 35,378 (6.1%) self-reported CHD. Compared with non-Hispanic whites, Native Americans were more likely to report fair/poor health status (adjusted odds ratio [AOR], 1.7), 14 or more total unhealthy days (AOR, 1.6), 14 or more physically unhealthy days (AOR, 1.7), and 14 or more activity-limited days (AOR, 1.9). Hispanics were more likely than non-Hispanic whites to report fair/poor health status (AOR, 1.5) and less likely to report 14 or more activity-limited days (AOR, 0.5), and Asians were less likely to report 14 or more activity-limited days (AOR, 0.2). Non-Hispanic blacks did not differ in unhealthy days measurements from non-Hispanic whites. The proportion reporting 14 or more total unhealthy days increased with increasing age, was higher among women than men, and was lower with increasing levels of education and income. CONCLUSION: There are sex, racial/ethnic, and socioeconomic disparities in HRQOL among people with CHD. Tailoring interventions to people who have both with CHD and poor HRQOL may assist in the overall management of CHD. |
Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007
Fang J , Gillespie C , Keenan NL , Greenlund KJ . Future Cardiol 2011 7 (3) 311-20 OBJECTIVE: Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults. METHOD: We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years. RESULTS: In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p < 0.01). Compared to 2001, the odds ratio of awareness in 2007 was 1.08 (95% CI: 0.99-1.19) after controlling for socioeconomic and clinical characteristics. CONCLUSION: Awareness of all heart attack symptoms among adults in 12 states was low and little improvement was observed between 2001 and 2007. Accordingly, both clinicians and public health officials should seek ways in order to increase public awareness of the symptoms of heart attack. Special efforts should be focused on men, Black and Hispanic people and those with only modest levels of education. |
Proceedings from the workshop on estimating the contributions of sodium reduction to preventable death
Schmidt SM , Andrews T , Bibbins-Domingo K , Burt V , Cook NR , Ezzati M , Geleijnse JM , Homer J , Joffres M , Keenan NL , Labarthe DR , Law M , Loria CM , Orenstein D , Schooley MW , Sukumar S , Hong Y . CVD Prev Control 2011 6 (2) 35-40 The primary goal of this workshop was to identify the most appropriate method to estimate the potential effect of reduction in sodium consumption on mortality. Difficulty controlling hypertension at the individual level has motivated international, federal, state, and local efforts to identify and implement population-wide strategies to better control this problem; reduction of sodium intake is one such strategy. Published estimates of the impact of sodium consumption on mortality have used different modeling approaches, effect sizes, and levels of sodium consumption, and thus their estimates of preventable deaths averted vary widely, and are not comparable. In response to this problem, the Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention (DHDSP) convened and facilitated a workshop to examine different methods of estimating the effect of sodium reduction on mortality. The panelists agreed that any of the methodologies presented could provide reasonable estimates, and therefore discussion focused on challenges faced by all methods. The panel concluded that future sodium modeling efforts should generate multiple estimates employing the same scenarios and effect sizes while using different modeling techniques; in addition, future efforts should include outcomes other than mortality (morbidity, costs, and quality of life). Varying reductions in sodium should be modeled at the population level over different time intervals. In an effort to better address some of the uncertainties highlighted by this workshop, the panelists are currently considering developing multiple estimates in a collaborative manner to clarify the potential impact of population-based interventions to reduce sodium consumption. |
Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults - HealthStyles, 2008
Valderrama AL , Tong X , Ayala C , Keenan NL . J Clin Hypertens (Greenwich) 2010 12 (10) 784-792 Lifestyle changes, such as changes in diet and exercise, are recommended to lower blood pressure (BP) in adults. Using data from the 2008 HealthStyles survey, the authors estimated the prevalence of self-reported hypertension, advice received from health professionals, and actions taken to reduce BP. Among 5399 respondents, 25.8% had hypertension and 79.8% of these were currently taking antihypertensive medications. Overall, 21.0% to 24.4% reported receiving advice to adopt specific behavior changes, with younger adults and women having a lower prevalence of receiving advice. Blacks had the highest prevalence among the racial/ethnic groups of receiving advice, and household income was associated with receiving advice. More than half of respondents took action following the receipt of advice. Women were more likely than men to follow advice to go on a diet. Although many patients were following advice from their health professional and making lifestyle changes to decrease BP, the proportion of patients making changes remains suboptimal. Receiving advice from health professionals and following recommendations to reduce or control high BP are essential to hypertension management. Counseling on lifestyle modification should continue to be an integral component of visits to health professionals. 2010 Wiley Periodicals, Inc. |
Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999-2006
Kuklina EV , Yoon PW , Keenan NL . Ann Fam Med 2010 8 (4) 327-33 PURPOSE: Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults. METHODS: National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999-2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines. RESULTS: About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C. CONCLUSIONS: CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted. |
Fruits and vegetables intake and physical activity among hypertensive adults in the United States: Behavioral Risk Factor Surveillance System, 2003 and 2007
Fang J , Keenan NL , Ayala C , Dai S , Valderrama AL . Am J Hypertens 2010 23 (7) 762-6 BACKGROUND: Consuming enough fruits and vegetables and engaging in regular physical activity are believed to be two important components of several lifestyle modifications for people with hypertension. The purpose of this study was to measure the degree to which US adults with hypertension achieved recommended intakes of fruits and vegetables and engaged in recommended levels of physical activity in 2003 and 2007. METHODS: Using the Behavioral Risk Factor Surveillance System (BRFSS) data conducted in 2003 (N = 264,178) and 2007 (N = 430,082), we determined the changes in the prevalence of eating ≥5 servings of fruits and vegetables and of obtaining Healthy People 2010 recommended level of physical activity among adults with hypertension during the period. RESULTS: In 2003 and 2007, among individuals with hypertension, age-adjusted prevalences of eating ≥5 servings of fruits and vegetables were 23.8 and 24.4% (P = 0.394) and meeting a recommended physical activity level were 38.2 and 40.3% (P < 0.001). With 2003 as the reference, odds ratios (95% confidence interval) of eating ≥5 servings of fruits and vegetables and meeting a recommended physical activity for 2007 were 1.02 (0.97-1.08) and 1.06 (1.01-1.10), respectively, after adjusting for relevant factors. CONCLUSIONS: Among hypertensives, less than a quarter are eating five or more servings of fruits and vegetables per day, and less than half are meeting recommended physical activity. In 4 years, there was no statistically significant improvement in intake of fruits and vegetables and just a slight, albeit statistically significant, improvement in physical activity among US adults. American Journal of Hypertension 2010; doi:10.1038/ajh.2010.46. |
Acute myocardial infarction hospitalization in the United States, 1979 to 2005
Fang J , Alderman MH , Keenan NL , Ayala C . Am J Med 2010 123 (3) 259-66 BACKGROUND: We reported earlier that there was no decline of acute myocardial infarction hospitalization from 1988 to 1997. We now extend these observations to document trends in acute myocardial infarction hospitalization rates and in-hospital case-fatality rates for 27 years from 1979 to 2005. METHODS: We determined hospitalization rates for acute myocardial infarction by age and gender using data from the National Hospital Discharge Survey and US civilian population from 1979 to 2005, aggregated by 3-year groupings. We also assessed comorbid, complications, cardiac procedure use, and in-hospital case-fatality rates. RESULTS: Age-adjusted hospitalization rate for acute myocardial infarction identified by primary International Classification of Diseases code was 215 per 100,000 people in 1979-1981 and increased to 342 in 1985-1987. Thereafter, the rate stabilized for the next decade and then declined slowly after 1996 to 242 in 2003-2005. Trends were similar for men and women, although rates for men were almost twice that of women. Hospitalization rates increased substantially with age and were the highest among those aged 85 years or more. Although median hospital stay decreased from 12 to 4 days, intensity of hospital care increased, including use of coronary angioplasty, coronary bypass, and thrombolytics therapy. During the period, reported comorbidity from diabetes and hypertension increased. Acute myocardial infarction complicated by heart failure increased, and cardiogenic shock decreased. Altogether, the in-hospital case-fatality rate declined. CONCLUSION: During the past quarter century, hospitalization for acute myocardial infarction increased until the mid-1990s, but has declined since then. At the same time, in-hospital case-fatality rates declined steadily. This decline has been associated with more aggressive therapeutic intervention. |
Health care services provided during physician office visits for hypertension: differences by specialty
Fang J , Keenan NL , Ayala C . J Clin Hypertens (Greenwich) 2010 12 (2) 89-95 J Clin Hypertens (Greenwich). 2010;12:89-95. ((c))2009 Wiley Periodicals, Inc. The changing health care system has reduced patients' access to specialty care. Often, patients with hypertension visit noncardiologists. The objective of this study is to compare differences by physician specialty in the provision of health care services during office visits for hypertension. The authors examined office visits for US physicians by using data from the National Ambulatory Medical Care Survey for 2003 to 2005. Of more than 274 million hypertension visits, 35.5%, 43.9%, 8.5%, and 12.1% visits were made to general practitioners/family physicians, internists, cardiologists, and other specialties, respectively. Visitors to cardiologists were more likely to have coronary heart disease and heart failure than visitors to other physicians. While prescriptions for antihypertensive drugs overall were similar by specialty, cardiologists were more likely to prescribe lipid-lowering drugs (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.14-2.24) and aspirin (OR, 2.76; 95% CI, 1.81-4.20), calcium channel blockers (OR, 1.48; 95% CI, 1.12-1.96), beta-blockers (OR, 1.83; 95% CI, 1.35-2.48), and alpha-blockers (OR, 2.10; 95% CI, 1.46-2.95) than general practitioners/family physicians after adjusting for relevant risk factors. There was no difference by specialty in providing/making a referral for nutrition/exercise counseling among physicians. Among hypertension office visits in the United States, cardiologists were more likely to provide lipid-lowering drugs, aspirin, calcium channel blocker, beta-blockers, and alpha-blockers than other physicians. |
Trends in high levels of low-density lipoprotein cholesterol in the United States, 1999-2006
Kuklina EV , Yoon PW , Keenan NL . JAMA 2009 302 (19) 2104-10 CONTEXT: Studies show that a large proportion of adults with high levels of low-density lipoprotein cholesterol (LDL-C) remain untreated or undertreated despite growing use of lipid-lowering medications. OBJECTIVE: To investigate trends in screening prevalence, use of cholesterol-lowering medications, and LDL-C levels across 4 study cycles (1999-2000, 2001-2002, 2003-2004, and 2005-2006). DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. After we restricted the study sample to fasting participants aged 20 years or older (n = 8018) and excluded pregnant women (n = 464) and participants with missing data (n = 510), our study sample consisted of 7044 participants. MAIN OUTCOME MEASURE: High LDL-C levels, defined as levels above the specific goal for each risk category outlined in guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All presented results are weighted and age-standardized to 2000 standard population estimates. RESULTS: Prevalence of high LDL-C levels among persons aged 20 years or older decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006 (P < .001 for linear trend) but varied by risk category. By the 2005-2006 study cycle, prevalence of high LDL-C was 58.9%, 30.2%, and 11.0% for high-, intermediate-, and low-risk categories, respectively. Self-reported use of lipid-lowering medications increased from 8.0% to 13.4% (P < .001 for linear trend), but screening rates did not change significantly, remaining less than 70% (P = .16 for linear trend) during the study periods. CONCLUSIONS: Among the NHANES population aged 20 years or older, the prevalence of high LDL-C levels decreased from 1999-2000 to 2005-2006. In the most recent period, the prevalence was 21.2%. |
Factors explaining excess stroke prevalence in the US Stroke Belt
Liao Y , Greenlund KJ , Croft JB , Keenan NL , Giles WH . Stroke 2009 40 (10) 3336-41 BACKGROUND AND PURPOSE: Higher risk and burden of stroke have been observed within the southeastern states (the Stroke Belt) compared with elsewhere in the United States. We examined reasons for these disparities using a large data set from a nationwide cross-sectional study. METHODS: Self-reported data from the 2005 and 2007 Behavioral Risk Factor Surveillance System were used (n=765 368). The potential contributors for self-reported stroke prevalence (n=27 962) were demographics (age, sex, geography, and race/ethnicity), socioeconomic status (education and income), common risk factors (smoking and obesity), and chronic diseases (hypertension, diabetes, and coronary heart disease). Multivariate logistic regression was used in the analysis. RESULTS: The age- and sex-adjusted OR comparing self-reported stroke prevalence in the 11-state Stroke Belt versus non-Stroke Belt region was 1.25 (95% CI, 1.19 to 1.31). Unequal black/white distribution by region accounted for 20% of the excess prevalence in the Stroke Belt (OR reduced to 1.20; 1.15 to 1.26). Approximately one third (32%) of the excess prevalence was accounted either by socioeconomic status alone or by risk factors and chronic disease alone (OR, 1.12). The OR was further reduced to 1.07 (1.02 to 1.13) in the fully adjusted logistic model, a 72% reduction. CONCLUSIONS: Differences in socioeconomic status, risk factors, and prevalence of common chronic diseases account for most of the regional differences in stroke prevalence. |
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