Publications (309) View all
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Dataset: ACP J Club Writeup
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Article: The Reply.
The American journal of medicine 04/2013; 126(4):e7. · 4.47 Impact Factor -
Article: Impact of Adding Aspirin to Beta-Blocker and Statin in High-Risk Patients Undergoing Major Vascular Surgery.
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ABSTRACT: BACKGROUND: Beta-blockers (BB) and statins (S) independently have been shown to reduce perioperative mortality and myocardial infarction (MI) in patients undergoing vascular surgery. In this study we evaluated the benefits of adding aspirin (A) to BB and S (ABBS), with/without angiotensin-converting enzyme inhibitor (ACE-I) on postoperative outcome in high-risk patients undergoing major vascular surgery. METHODS: Analysis of consecutive patients undergoing elective vascular surgery at the University of Michigan Cardiovascular Center was performed. Univariate and multivariate analyses were done using cardiac risk index [Revised Cardiac Risk Index (RCRI), coronary artery disease (CAD), insulin-dependent diabetes mellitus (IDDM), cerebral vascular disease, renal dysfunction, congestive heart failure, and major surgery]; pulmonary disease; and A, BB, S (ABBS) ± ACE-I use. Baseline clinical characteristics and medication were adjusted using propensity scores. Endpoints were bleeding, 30-day MI, stroke, and 12-month mortality. RESULTS: Between 2003 and 2010, 4,149 arterial procedures were performed, 819 of which were risk stratified as RCRI ≥3. The incidence of MI was 3-fold lower (2.5% vs. 7.8%, OR 0.31, 95% CI 0.15-0.61, P = 0.001) in ABBS ± ACE-I (n = 513) as compared with non-ABBS ± ACE-I (n = 306). The 12-month mortality was 8-fold lower in ABBS ± ACE-I as compared non-ABBS ± ACE-I (5.9% vs. 37.5%, HR 0.13, 95% CI 0.08-0.20, P < 0.0001). After adjustment for the propensity to use various therapies, A (HR 0.35, 95% CI 0.24-0.53, P < 0.0001), BB (HR 0.65, 95% CI 0.43-1.0, P = 0.05), and S (HR 0.36, 95% CI 0.25-0.53, P < 0.0001) remained associated with improved 12-month survival. ACE-I use (HR 0.80, 95% CI 0.54-1.19, P = 0.27) was not predictive. Aspirin did not predict severe/moderate bleeding. CONCLUSIONS: In high-risk patients undergoing major vascular surgery, ABBS therapy has superior 30-day and 12-month risk reduction benefits for MI, stroke, and mortality as compared with A, BB, or S independently. ACE-I did not demonstrate additional risk-reduction benefits.Annals of Vascular Surgery 03/2013; · 1.03 Impact Factor -
Article: Effect of obesity on in-hospital treatment for acute coronary syndrome complicated by new-onset heart failure.
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ABSTRACT: OBJECTIVE: Obesity has been associated with superior outcomes in heart failure (HF) and acute coronary syndrome (ACS). Although patients with new-onset HF after ACS are at a high risk, they may receive less aggressive treatment. It is unknown whether treatment practices are biased by BMI. METHODS AND RESULTS: Consecutive patients without previous HF, who were hospitalized with ACS, and had left ventricular ejection fraction less than 40% or clinical HF were analyzed to assess the utilization of evidence-based treatment by BMI. BMI was categorized into normal (18.5 to <25 kg/m), overweight (25 to <30 kg/m), and obese (≥30 kg/m) groups. Multivariable logistic regression models were performed to examine the association of BMI with undergoing cardiac catheterization, and discharge on β-blocker or angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Analysis included 461 patients. There were no significant differences among BMI groups in performance of cardiac catheterization or discharge on ACE inhibitor/ARB or β-blocker. Compared with normal, neither overweight nor obese BMI was significantly associated with cardiac catheterization [overweight: odds ratio (OR) 1.49, 95% confidence interval (CI) 0.82-2.72, P=0.2; obese: OR 1.75, 95% CI 0.92-3.33, P=0.09], or discharge on ACE inhibitor/ARB (overweight: OR 0.70, 95% CI 0.40-1.21, P=0.7; obese: OR 0.69, 95% CI 0.39-1.23, P=0.2), or β-blocker (overweight: OR 1.24, 95% CI 0.69-2.21, P=0.5; obese: OR 1.13, 95% CI 0.62-2.07, P=0.7). CONCLUSION: Among patients with new-onset HF complicating ACS, there were no significant differences in evidence-based treatment practices by BMI.Coronary artery disease 03/2013; · 1.56 Impact Factor -
Article: Recovery Heart Rate: An Indicator of Cardiovascular Risk Among Middle School Children.
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ABSTRACT: Recovery heart rate (RHR) has been used in adults to evaluate cardiovascular (CV) fitness, but less is known about RHR in children. Data from 1,276 participants in Project Healthy Schools, a school-based intervention in southeast Michigan, were collected. In addition, to demographic characteristics, physiologic factors examined included body mass index (BMI), lipid and glucose levels, blood pressure, and HR. Information on diet, physical activity, and sedentary behavior was collected through self-report. RHR was determined by measurement of HR after a 3-minute step test. Using quartiles of RHR as a marker of fitness, associations with demographic, physiologic, and behavioral factors were explored using χ2 and Student t tests. Compared with children in the lowest quartile of RHR (i.e., most fit), those in the upper quartile of RHR (i.e., least fit) had greater mean LDL cholesterol (93.0 vs. 86.7 mg/dL; P = 0.02) and lower mean HDL cholesterol (50.9 vs. 55.9 mg/dL; P < 0.001). Children in the upper 95 % of BMI had greater mean RHR compared with those in the normal BMI range (116.6 vs. 100.3 kg/m2). Children in the upper quartile of RHR reported fewer days of vigorous to moderate exercise per week compared with children in the lowest quartile of RHR [4.8 vs. 4.1 (P < 0.001) for moderate exercise and 3.6 vs. 3.0 (P = 0.001) for vigorous exercise]. Among middle school children, RHR appears to be associated with physiologic parameters and health behaviors. RHR may be useful for identifying children at increased risk for developing CV risk factors.Pediatric Cardiology 03/2013; · 1.30 Impact Factor
