Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Mensah GA[original query] |
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Correction: A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health.
Khoury MJ , Feero WG , Chambers DA , Brody LC , Aziz N , Green RC , Janssens Acjw , Murray MF , Rodriguez LL , Rutter JL , Schully SD , Winn DM , Mensah GA . PLoS Med 2018 15 (8) e1002650 The fourth author’s name is incorrect. The correct name is Lawrence C. Brody. The correct citation is: Khoury MJ, Feero WG, Chambers DA, Brody LC, Aziz N, Green RC, et al. (2018) A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health. PLoS Med 15(8): e1002631. https://doi.org/10.1371/journal.pmed.1002631. |
Cardiopulmonary impact of particulate air pollution in high-risk populations: JACC State-of-the-Art Review
Newman JD , Bhatt DL , Rajagopalan S , Balmes JR , Brauer M , Breysse PN , Brown AGM , Carnethon MR , Cascio WE , Collman GW , Fine LJ , Hansel NN , Hernandez A , Hochman JS , Jerrett M , Joubert BR , Kaufman JD , Malik AO , Mensah GA , Newby DE , Peel JL , Siegel J , Siscovick D , Thompson BL , Zhang J , Brook RD . J Am Coll Cardiol 2020 76 (24) 2878-2894 Fine particulate air pollution <2.5 μm in diameter (PM(2.5)) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM(2.5) as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM(2.5) can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention. |
Precision Health Analytics With Predictive Analytics and Implementation Research: JACC State-of-the-Art Review.
Pearson TA , Califf RM , Roper R , Engelgau MM , Khoury MJ , Alcantara C , Blakely C , Boyce CA , Brown M , Croxton TL , Fenton K , Green Parker MC , Hamilton A , Helmchen L , Hsu LL , Kent DM , Kind A , Kravitz J , Papanicolaou GJ , Prosperi M , Quinn M , Price LN , Shireman PK , Smith SM , Szczesniak R , Goff DC Jr , Mensah GA . J Am Coll Cardiol 2020 76 (3) 306-320 Emerging data science techniques of predictive analytics expand the quality and quantity of complex data relevant to human health and provide opportunities for understanding and control of conditions such as heart, lung, blood, and sleep disorders. To realize these opportunities, the information sources, the data science tools that use the information, and the application of resulting analytics to health and health care issues will require implementation research methods to define benefits, harms, reach, and sustainability; and to understand related resource utilization implications to inform policymakers. This JACC State-of-the-Art Review is based on a workshop convened by the National Heart, Lung, and Blood Institute to explore predictive analytics in the context of implementation science. It highlights precision medicine and precision public health as complementary and compelling applications of predictive analytics, and addresses future research and training endeavors that might further foster the application of predictive analytics in clinical medicine and public health. |
Perspective: The Clinical Use of Polygenic Risk Scores: Race, Ethnicity, and Health Disparities.
Roberts MC , Khoury MJ , Mensah GA . Ethn Dis 2019 29 (3) 513-516 Polygenic risk scores (PRS) are an emerging precision medicine tool based on multiple gene variants that, taken alone, have weak associations with disease risks, but collectively may enhance disease predictive value in the population. However, the benefit of PRS may not be equal among non-European populations, as they are under-represented in genome-wide association studies (GWAS) that serve as the basis for PRS development. In this perspective, we discuss a path forward, which includes: 1) inclusion of underrepresented populations in PRS research; 2) global efforts to build capacity for genomic research; 3) equitable implementation of these tools in clinical practice; and 4) traditional public health approaches to reduce risk of adverse health outcomes as an important component to precision health. As precision medicine is implemented in clinical care, researchers must ensure that advances from PRS research will benefit all. |
Beyond Public Health Genomics: Can Big Data and Predictive Analytics Deliver Precision Public Health?
Khoury MJ , Engelgau M , Chambers DA , Mensah GA . Public Health Genomics 2019 21 1-6 The field of public health genomics has matured in the past two decades and is beginning to deliver genomic-based interventions for health and health care. In the past few years, the terms precision medicine and precision public health have been used to include information from multiple fields measuring biomarkers as well as environmental and other variables to provide tailored interventions. In the context of public health, "precision" implies delivering the right intervention to the right population at the right time, with the goal of improving health for all. In addition to genomics, precision public health can be driven by "big data" as identified by volume, variety, and variability in biomedical, sociodemographic, environmental, geographic, and other information. Most current big data applications in health are in elucidating pathobiology and tailored drug discovery. We explore how big data and predictive analytics can contribute to precision public health by improving public health surveillance and assessment, and efforts to promote uptake of evidence-based interventions, by including more extensive information related to place, person, and time. We use selected examples drawn from child health, cardiovascular disease, and cancer to illustrate the promises of precision public health, as well as current methodologic and analytic challenges to big data to fulfill these promises. |
Emerging Concepts in Precision Medicine and Cardiovascular Diseases in Racial and Ethnic Minority Populations.
Mensah GA , Jaquish C , Srinivas P , Papanicolaou GJ , Wei GS , Redmond N , Roberts MC , Nelson C , Aviles-Santa L , Puggal M , Green Parker MC , Minear MA , Barfield W , Fenton KN , Boyce CA , Engelgau MM , Khoury MJ . Circ Res 2019 125 (1) 7-13 Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities; and the importance of ensuring ancestry-matched controls in variant interpretation. We address the relevance of epigenetics, pharmacogenomics, genetic testing and counseling, and their social and cultural implications. We also examine the potential impact of precision medicine on racial and ethnic disparities. The National Institutes of Health's All of Us Research Program and the National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Initiative are presented as examples of research programs at the forefront of precision medicine and diversity to explore research implications in minorities. We conclude with an overview of implementation research challenges in precision medicine and the ethical implications in minority populations. Successful implementation of precision medicine in cardiovascular disease in minority populations will benefit from strategies that directly address diversity and inclusion in genomics research and go beyond race and ethnicity to explore ancestry-matched controls, as well as geographic, cultural, social, and environmental determinants of health. |
Predictive analytics: Helping guide the implementation research agenda at the National Heart, Lung, and Blood Institute
Engelgau MM , Khoury MJ , Roper RA , Curry JS , Mensah GA . Glob Heart 2019 14 (1) 75-79 Global biomedical research investments have resulted | in important discoveries and many effective preventive and | therapeutic interventions for heart, lung, blood, and sleep | (HLBS) disorders—the focus areas for the National Heart, | Lung, and Blood Institute (NHLBI) at the National | Institutes of Health (NIH). In most high-income countries, | extensive efforts have synthesized this knowledge through | systematic reviews and developed evidence-based guidelines for intervention delivery within health care systems | and community-based settings [1e7]. In low- and middleincome countries, the World Economic Forum and World | Health Organization have studied the economic toll of | noncommunicable diseases and the cost of scaling up a set | of proven-effective interventions, so-called best buys (e.g., | providing drug therapy and counseling for eligible persons | at high risk to prevent heart attacks and strokes) [8]. Thus, | effective interventions are now available and recommended | for implementation across the globe. However, adaptable | and sustainable implementation strategies for HLBS interventions are lacking and return on investment for this | vast knowledge base is diminished. This has led many to | call for a more developed implementation research | agenda—including leadership from institutions such as the | World Health Organization [9], World Bank [10], | academia [11], US Agency for International Development | [12], and NIH [13e19]. |
Leveraging implementation science to address health disparities in genomic medicine: Examples from the field
Roberts MC , Mensah GA , Khoury MJ . Ethn Dis 2019 29 187-192 The integration of genomic data into screening, prevention, diagnosis, and treatment for clinical and public health practices has been slow and challenging. Implementation science can be applied in tackling the barriers and challenges as well as exploring opportunities and best practices for integrating genomic data into routine clinical and public health practice.In this article, we define the state of disparities in genomic medicine and focus predominantly on late-stage research findings. We use case studies from genetic testing for cardiovascular diseases (familial hypercholesterolemia) and cancer (Lynch syndrome and hereditary breast and ovarian cancer syndrome) in high-risk populations to consider current disparities and related barriers in turning genomic advances into population health impact to advance health equity. Finally, we address how implementation science can address these translational barriers and we discuss the strategic importance of collaborative multi-stakeholder approaches that engage public health agencies, professional societies, academic health and research centers, community clinics, and patients and their families to work collectively to improve population health and reduce or eliminate health inequities. |
HLBS-PopOmics: an online knowledge base to accelerate dissemination and implementation of research advances in population genomics to reduce the burden of heart, lung, blood, and sleep disorders.
Mensah GA , Yu W , Barfield WL , Clyne M , Engelgau MM , Khoury MJ . Genet Med 2018 21 (3) 519-524 Recent dramatic advances in multiomics research coupled with exponentially increasing volume, complexity, and interdisciplinary nature of publications are making it challenging for scientists to stay up-to-date on the literature. Strategies to address this challenge include the creation of online databases and warehouses to support timely and targeted dissemination of research findings. Although most of the early examples have been in cancer genomics and pharmacogenomics, the approaches used can be adapted to support investigators in heart, lung, blood, and sleep (HLBS) disorders research. In this article, we describe the creation of an HLBS population genomics (HLBS-PopOmics) knowledge base as an online, continuously updated, searchable database to support the dissemination and implementation of studies and resources that are relevant to clinical and public health practice. In addition to targeted searches based on the HLBS disease categories, cross-cutting themes reflecting the ethical, legal, and social implications of genomics research; systematic evidence reviews; and clinical practice guidelines supporting screening, detection, evaluation, and treatment are also emphasized in HLBS-PopOmics. Future updates of the knowledge base will include additional emphasis on transcriptomics, proteomics, metabolomics, and other omics research; explore opportunities for leveraging data sets designed to support scientific discovery; and incorporate advanced machine learning bioinformatics capabilities. |
A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health
Khoury MJ , Feero WG , Chambers DA , Brody LE , Aziz N , Green RC , Janssens Acjw , Murray MF , Rodriguez LL , Rutter JL , Schully SD , Winn DM , Mensah GA . PLoS Med 2018 15 (8) e1002631 In a Policy Forum, Muin Khoury and colleagues discuss research on the clinical application of genome sequencing data. |
Implementation research to address the United States health disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop
Engelgau MM , Narayan KMV , Ezzati M , Salicrup LA , Belis D , Aron LY , Beaglehole R , Beaudet A , Briss PA , Chambers DA , Devaux M , Fiscella K , Gottlieb M , Hakkinen U , Henderson R , Hennis AJ , Hochman JS , Jan S , Koroshetz WJ , Mackenbach JP , Marmot MG , Martikainen P , McClellan M , Meyers D , Parsons PE , Rehnberg C , Sanghavi D , Sidney S , Siega-Riz AM , Straus S , Woolf SH , Constant S , Creazzo TL , de Jesus JM , Gavini N , Lerner NB , Mishoe HO , Nelson C , Peprah E , Punturieri A , Sampson U , Tracy RL , Mensah GA . Glob Heart 2018 13 (2) 65-72 Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes. |
Research needs to improve hypertension treatment and control in African Americans
Whelton PK , Einhorn PT , Muntner P , Appel LJ , Cushman WC , Diez Roux AV , Ferdinand KC , Rahman M , Taylor HA , Ard J , Arnett DK , Carter BL , Davis BR , Freedman BI , Cooper LA , Cooper R , Desvigne-Nickens P , Gavini N , Go AS , Hyman DJ , Kimmel PL , Margolis KL , Miller ER 3rd , Mills KT , Mensah GA , Navar AM , Ogedegbe G , Rakotz MK , Thomas G , Tobin JN , Wright JT , Yoon SS , Cutler JA . Hypertension 2016 Additional targeted research and customized training programs could spearhead strategies for elimination of the disparities in prevalence and control of high BP between African Americans and the remainder of the US general population. | This report presents findings of an ad hoc working group assembled by the National Heart, Lung, and Blood Institute (NHLBI) to assess research needs to improve prevention, treatment and control of hypertension among African Americans. Non-Hispanic Blacks (African American and Black will be used for US and international studies, respectively) tend to have an earlier onset, higher prevalence, and disproportionately high risk of complications for hypertension compared to non-Hispanic Whites and Mexican Americans.1 |
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities Think Tank meeting
Sampson UK , Kaplan RM , Cooper RS , Diez Roux AV , Marks JS , Engelgau MM , Peprah E , Mishoe H , Boulware LE , Felix KL , Califf RM , Flack JM , Cooper LA , Gracia JN , Henderson JA , Davidson KW , Krishnan JA , Lewis TT , Sanchez E , Luban NL , Vaccarino V , Wong WF , Wright JT Jr , Meyers D , Ogedegbe OG , Presley-Cantrell L , Chambers DA , Belis D , Bennett GC , Boyington JE , Creazzo TL , de Jesus JM , Krishnamurti C , Lowden MR , Punturieri A , Shero ST , Young NS , Zou S , Mensah GA . J Am Coll Cardiol 2016 68 (5) 517-24 The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. The panel recommended several specific actions, including: 1) embrace broad and inclusive research themes; 2) develop research platforms that optimize the ability to conduct informative and innovative research, and promote systems science approaches; 3) develop networks of collaborators and stakeholders, and launch transformative studies that can serve as benchmarks; 4) optimize the use of new data sources, platforms, and natural experiments; and 5) develop unique transdisciplinary training programs to build research capacity. Confronting health inequities will require engaging multiple disciplines and sectors (including communities), using systems science, and intervening through combinations of individual, family, provider, health system, and community-targeted approaches. Details of the panel's remarks and recommendations are provided in this report. |
Prevention of stroke: a strategic global imperative
Feigin VL , Norrving B , George MG , Foltz JL , Roth GA , Mensah GA . Nat Rev Neurol 2016 12 (9) 501-12 The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs. |
The state of US health, 1990-2010: burden of diseases, injuries, and risk factors
Murray CJ , Abraham J , Ali MK , Alvarado M , Atkinson C , Baddour LM , Bartels DH , Benjamin EJ , Bhalla K , Birbeck G , Bolliger I , Burstein R , Carnahan E , Chen H , Chou D , Chugh SS , Cohen A , Colson KE , Cooper LT , Couser W , Criqui MH , Dabhadkar KC , Dahodwala N , Danaei G , Dellavalle RP , Des Jarlais DC , Dicker D , Ding EL , Dorsey ER , Duber H , Ebel BE , Engell RE , Ezzati M , Felson DT , Finucane MM , Flaxman S , Flaxman AD , Fleming T , Forouzanfar MH , Freedman G , Freeman MK , Gabriel SE , Gakidou E , Gillum RF , Gonzalez-Medina D , Gosselin R , Grant B , Gutierrez HR , Hagan H , Havmoeller R , Hoffman H , Jacobsen KH , James SL , Jasrasaria R , Jayaraman S , Johns N , Kassebaum N , Khatibzadeh S , Knowlton LM , Lan Q , Leasher JL , Lim S , Lin JK , Lipshultz SE , London S , Lozano R , Lu Y , Macintyre MF , Mallinger L , McDermott MM , Meltzer M , Mensah GA , Michaud C , Miller TR , Mock C , Moffitt TE , Mokdad AA , Mokdad AH , Moran AE , Mozaffarian D , Murphy T , Naghavi M , Narayan KM , Nelson RG , Olives C , Omer SB , Ortblad K , Ostro B , Pelizzari PM , Phillips D , Pope CA , Raju M , Ranganathan D , Razavi H , Ritz B , Rivara FP , Roberts T , Sacco RL , Salomon JA , Sampson U , Sanman E , Sapkota A , Schwebel DC , Shahraz S , Shibuya K , Shivakoti R , Silberberg D , Singh GM , Singh D , Singh JA , Sleet DA , Steenland K , Tavakkoli M , Taylor JA , Thurston GD , Towbin JA , Vavilala MS , Vos T , Wagner GR , Weinstock MA , Weisskopf MG , Wilkinson JD , Wulf S , Zabetian A , Lopez AD . JAMA 2013 310 (6) 591-608 IMPORTANCE: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. |
Geographic variations in heart failure hospitalizations among Medicare beneficiaries in the Tennessee catchment area
Ogunniyi MO , Holt JB , Croft JB , Nwaise IA , Okafor HE , Sawyer DB , Giles WH , Mensah GA . Am J Med Sci 2011 343 (1) 71-7 INTRODUCTION: Although differences in heart failure (HF) hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalizations for HF, the most common discharge diagnosis for Medicare beneficiaries. METHODS: Using exploratory spatial data analysis techniques, the authors examined hospitalization rates for HF as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. RESULTS: The age-adjusted HF hospitalization rate (per 1000) among Medicare beneficiaries was 23.3 [95% confidence interval (CI), 23.3-23.4] for the Tennessee catchment area, 21.4 (95% CI, 21.4-21.5) outside the catchment area and 21.9 (95% CI, 21.9-22.0) for the overall United States. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than outside the catchment area and overall, among men, women and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6 +/- 7.6) and Kentucky (29.2 +/- 11.5), and the lowest were in North Carolina (21.7 +/- 5.7) and Virginia (21.8 +/- 6.6). CONCLUSIONS: Knowledge of these geographic differences in HF hospitalization rates can be useful in identifying needs of healthcare providers, allocating resources, developing comprehensive HF outreach programs and formulating policies to reduce these differences. |
Racial/ethnic differences in microalbuminuria among adults with prehypertension and hypertension: National Health and Nutrition Examination Survey (NHANES), 1999-2006
Ogunniyi MO , Croft JB , Greenlund KJ , Giles WH , Mensah GA . Am J Hypertens 2010 23 (8) 859-64 BACKGROUND: Microalbuminuria, a biomarker of endothelial dysfunction, is associated with increased cardiovascular, renal, and cerebrovascular morbidity and mortality, especially among ethnic minorities. METHODS: A total of 16,567 adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006 were categorized according to JNC 7 blood pressure (BP) definitions. Microalbuminuria was defined as spot urinary albumin/creatinine ratio (ACR) of 30-299 mg/g. Logistic regression estimated the odds of having microalbuminuria among BP categories compared with normal BP after adjusting for age, race/ethnicity, sex, education level, smoking status, body mass index (BMI), systolic BP, and diabetes. RESULTS: Prevalence of microalbuminuria was 4.5% for normal BP, 6.3% for prehypertension, 12.4% for stage 1 hypertension, 25.3% for stage 2 hypertension, and 11.3% among those with treated, controlled hypertension. Compared with participants with normal BP, the adjusted odds ratios and 95% confidence intervals (CIs) for microalbuminuria were 1.3 (1.0-1.7, P = 0.03) for those with prehypertension, 2.3 (1.8-3.0, P < 0.01) with stage 1 hypertension, 4.8 (3.7-6.3 P < 0.01) with stage 2 hypertension, and 1.6 (1.3-2.1, P < 0.01) with treated, controlled hypertension. The treated controlled hypertension group exhibited the strongest race-ethnicity gradient. CONCLUSIONS: Participants with hypertension and prehypertension had a higher likelihood of microalbuminuria than those with normal BP, especially ethnic minorities, suggesting greater target organ damage. Our observations suggest that further research is necessary to determine whether microalbuminuria can be used as a screening tool in adults with prehypertension, to identify adults at highest risk for cardiovascular disease or decline in renal function.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.77. |
Fifth Pivotal Research in Cardiology in the Elderly (PRICE-V) symposium: preventive cardiology in the elderly--executive summary. Part II: afternoon session
Rich MW , Mensah GA . Prev Cardiol 2010 13 (1) 42-7 Closing Plenary Lecture: Aging and Preventive Cardiology in the United States: A Framework for Action | The aging process, an unavoidable phenomenon that begins at birth and accelerates with advancing age, is a powerful independent risk factor for cardiovascular diseases. Scientific evidence presented at this symposium suggests that although the process is unavoidable, its pathophysiologic derangements are accelerated in the setting of adverse psychosocial, environmental, behavioral, and biological risk factors. Most prominent among these are physical inactivity, poor nutrition, obesity, tobacco use, hypertension, diabetes, and dyslipidemia. Not surprisingly, the aging of the US population coupled with the high prevalence of obesity and other risk factors has led to an increasing burden of cardiovascular morbidity, disability, and frailty, especially in the elderly. | The good news is that effective strategies exist for the prevention and control of these risk factors and for effective promotion of high-quality cardiovascular health, overall well-being, and prevention of premature frailty. The 6 plenary sessions in this conference addressed many of these strategies. The central challenge for preventive cardiology is how best to translate these scientific advances into practice. What is an ideal framework for translating the basic, clinical, and population science research findings to the desired outcomes of reducing mortality, increasing quality of life, eliminating disparities, and preventing frailty in the elderly? | The American College of Cardiology, in its 33rd Bethesda conference (Preventive Cardiology: How Can We Do Better?),1 tackled this issue. Similarly, the American Heart Association, the World Heart Federation, and the World Health Organization have produced documents and scientific statements that provide guidance on promoting “active aging” or “healthy aging.” In the United States, several federal agencies, including the National Institute of Aging at the National Institutes of Health and the Centers for Disease Control and Prevention, have emphasized the importance of translating science into practice and have supported continued research in this arena. The multiple lessons learned from these endeavors have provided the basis for the conceptual framework for action addressed in the closing plenary lecture. | Key elements of the framework include: (1) major inputs, (2) strategic actions, (3) short- and intermediate-term outcomes, and (4) long-term outcomes. The projected manpower need for the preventive cardiology health care work force is a crucial input, especially as the first wave of baby boomers turns 65 in 2011. An effective network of federal, state, and local health departments as well as cardiology practices, health care centers, and community resources constitute additional inputs. Strategic actions include awareness and education campaigns, core essential preventive services, direct patient care, collaborative self-management support, and supportive health care policy and legislation. Well-defined short- and intermediate-term indicators measurable at the individual, health system, and societal levels are essential. Examples of such indicators include blood pressure and lipid control rates, the proportion of individuals who smoke, and the proportion who engage in regular physical activity. Improvements in quality of life and reductions in preventable mortality, frailty, and health disparities are appropriate long-term outcome measures. | It must be emphasized that this framework is only the initial phase of a model designed to help move science into clinical and public health practice for effective preventive cardiology. Active participation of governmental and nongovernmental partners from across multiple sectors and the keen commitment of policymakers, planners, practitioners, patients, and the public are essential to make the endeavor successful. Most importantly, continued surveillance and evaluation are necessary to ensure that intermediate- and long-term outcome objectives are being met and that broad support for the model inputs and strategic actions exist at the national, state, and local levels. |
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