Publications (23)64.64 Total impact
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Article: Hypertensive chronic kidney disease in African Americans: Strategies for improving care.
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ABSTRACT: African Americans have a disproportionate burden of chronic kidney disease (CKD), which tends to have an earlier onset and a more rapid progression in this population. Many of the factors responsible for the rapid progression of CKD in African Americans are detectable by screening and are modifiable with prompt therapy.Cleveland Clinic Journal of Medicine 10/2012; 79(10):726-34. · 3.77 Impact Factor -
Article: Kidney disease in disadvantaged populations.
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ABSTRACT: Disadvantaged populations across the globe exhibit a disproportionate burden of chronic kidney disease (CKD) because of differences in CKD occurrence and outcomes. Although many CKD risk factors can be managed and modified to optimize clinical outcomes, the prevailing socioeconomic and cultural factors in disadvantaged populations, more often than not, militate against optimum clinical outcomes. In addition, disadvantaged populations exhibit a broader spectrum of CKD risk factors and may be genetically predisposed to an earlier onset and a more rapid progression of chronic kidney disease. A basic understanding of the vulnerabilities of the disadvantaged populations will facilitate the adaptation and adoption of the kidney disease treatment and prevention guidelines for these vulnerable populations. The purpose of this paper is to examine recent discoveries and data on CKD occurrence and outcomes in disadvantaged populations and explore strategies for the prevention and treatment of CKD in these populations based on the established guidelines.International journal of nephrology. 01/2012; 2012:469265. -
Article: Vitamin D and cardiovascular disease: potential role in health disparities.
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ABSTRACT: Cardiovascular disease (CVD), which includes coronary artery disease and stroke, is the leading cause of mortality in the nation. Excess CVD morbidity and premature mortality in the African American community is one of the most striking examples of racial/ ethnic disparities in health outcomes. African Americans also suffer from increased rates of hypovitaminosis D, which has emerged as an independent risk factor for all-cause and cardiovascular mortality. This overview examines the potential role of hypovitaminosis D as a contributor to racial and ethnic disparities in cardiovascular disease (CVD). We review the epidemiology of vitamin D and CVD in African Americans and the emerging biological roles of vitamin D in key CVD signaling pathways that may contribute to the epidemiological findings and provide the foundation for future therapeutic strategies for reducing health disparities.Journal of Health Care for the Poor and Underserved 01/2011; 22(4 Suppl):23-38. · 1.10 Impact Factor -
Article: Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice.
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ABSTRACT: Background. Literature regarding the influence of age/sex on mortality trends for acute myocardial infarction (AMI) hospitalizations is limited to hospitals participating in voluntary AMI registries. Objective. Evaluate the impact of age and sex on in-hospital AMI mortality using a nationally representative hospital sample. Methods. Secondary data analysis using AMI hospitalizations identified from the Nationwide-Inpatient-Sample (NIS). Descriptive and Cox proportional hazards analysis explored mortality trends by age and sex from 1997-2006 while adjusting for the influence of, demographics, co-morbidity, length of hospital stay and hospital characteristics. Results. From 1997-2006, in-hospital AMI mortality rates decreased across time in all subgroups (P < .001), except for males aged <55 years. The greatest decline was observed in females aged <55 years, compared to similarly aged males, mortality outcomes were poorer in 1997-1998 (RR 1.47, 95% CI = 1.30-1.66), when compared with 2005-2006 (RR 1.03, 95% CI = 0.90-1.18), adjusted P value for trend demonstrated a statistically significant decline in the relative AMI mortality risk for females when compared with males (<0.001). Conclusion. Over the last decade, in-hospital AMI mortality rates declined for every age/sex group except males <55 years. While AMI female-male mortality disparity has narrowed, some room for improvement remains.Cardiology research and practice. 01/2010; 2010:752765. -
Article: Renal dysfunction, metabolic syndrome and cardiovascular disease mortality.
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ABSTRACT: Background. Renal disease is commonly described as a complication of metabolic syndrome (MetS) but some recent studies suggest that Chronic Kidney disease (CKD) may actually antecede MetS. Few studies have explored the predictive utility of co-clustering CKD with MetS for cardiovascular disease (CVD) mortality. Methods. Data from a nationally representative sample of United States adults (NHANES) was utilized. A sample of 13115 non-pregnant individuals aged >/=35 years, with available follow-up mortality assessment was selected. Multivariable Cox Proportional hazard regression analysis techniques explored the relationship between co-clustered CKD, MetS and CVD mortality. Bayesian analysis techniques tested the predictive accuracy for CVD Mortality of two models using co-clustered MetS and CKD and MetS alone. Results. Co-clustering early and late CKD respectively resulted in statistically significant higher hazard for CVD mortality (HR = 1.80, CI = 1.45-2.23, and HR = 3.23, CI = 2.56-3.70) when compared with individuals with no MetS and no CKD. A model with early CKD and MetS has a higher predictive accuracy (72.0% versus 67.6%), area under the ROC (0.74 versus 0.66), and Cohen's kappa (0.38 versus 0.21) than that with MetS alone. Conclusion. The study findings suggest that the co-clustering of early CKD with MetS increases the accuracy of risk prediction for CVD mortality.Journal of nutrition and metabolism 01/2010; 2010. -
Article: The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS.
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ABSTRACT: The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care. To estimate the association between HIV stigma and: self-reported access to care, regular source of HIV care, and antiretroviral therapy adherence; and to test whether mental health mediates these associations. Cross-sectional study. 202 PLHA living in Los Angeles County in 2007. Participants completed an anonymous survey, assessing internalized HIV stigma (28-items, alpha = 0.93), self-reported access to medical care (six items, alpha = 0.75), regular source of HIV care, and antiretroviral therapy (ART) adherence. One-third of participants reported high levels of stigma; 77% reported poor access to care; 42.5% reported suboptimal ART adherence; and 10.5% reported no regular source of HIV care. In unadjusted analysis, those reporting a high level of stigma were more likely to report poor access to care (OR = 4.97, 95% CI 2.54-9.72), regular source of HIV care (OR = 2.48, 95% CI 1.00-6.19), and ART adherence (OR = 2.45, 95% CI 1.23-4.91). In adjusted analyses, stigma was significantly associated with poor access to care (OR = 4.42, 95% CI 1.88-10.37), but not regular source of HIV care or ART adherence. Mental health mediated the relationship between stigma and ART adherence, but not poor access to care or regular source of HIV care. The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.Journal of General Internal Medicine 09/2009; 24(10):1101-8. · 2.83 Impact Factor -
Article: Chronic kidney disease, hypovitaminosis D, and mortality in the United States.
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ABSTRACT: Low serum 25-hydroxy vitamin D (25OHD) predicts a higher cardiovascular risk in the general population. Because patients with chronic kidney disease are more likely to have low serum 25OHD, we determined the relationship between hypovitaminosis D and death in this group. Analysis was done using a cohort composed of 3011 patients from the Third National Health and Nutrition Examination Survey who had chronic kidney disease but were not on dialysis and who had a mean follow-up of 9 years. In analyses adjusted for demographics, cardiovascular risk factors, serum phosphorus, albumin, hemoglobin, stage of chronic kidney disease, albuminuria, and socioeconomic status, individuals with serum 25OHD levels less than 15 ng/ml had an increased risk for all-cause mortality when compared to those with levels over 30 ng/ml. This significantly higher risk for death with low serum 25OHD was evident in 15 of the 23 subgroups. The higher risk for cardiovascular and non-cardiovascular mortality became statistically nonsignificant on multivariable adjustment. The trend for higher mortality in patients with 25OHD levels 15-30 ng/ml was not statistically significant. Our results indicate there is a graded relationship between serum 25OHD and the risk for death among subjects with chronic kidney disease who are not undergoing dialysis. Randomized, controlled trials are needed to conclusively determine whether vitamin D supplementation reduces mortality.Kidney International 09/2009; 76(9):977-83. · 6.61 Impact Factor -
Article: Implications of ethnicity for the treatment of hypertensive kidney disease, with an emphasis on African Americans.
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ABSTRACT: The recognition of chronic kidney disease (CKD) as an important public health issue has fostered an increasing number of strategies to increase CKD awareness and to reduce both the prevalence and the complications of CKD. Despite these advances, end-stage renal disease (ESRD) and cardiovascular events remain the major complications of CKD. Although the ESRD epidemic is attributed in greater part to the increasing rate of diabetes, hypertension remains the second most common reported cause of ESRD and is present in approximately 90% of cases of diabetes-related ESRD. The disproportionately high prevalence of hypertension in ethnic minorities, as well as the difficulty of achieving adequate blood-pressure control in these populations, contributes substantially to the high rate of CKD progression and complications in these groups. Although the role of hypertension as a primary cause of CKD is debated, hypertension is commonly recognized as the most important CKD progression factor. Important differences have been reported in the degree and likelihood of blood-pressure response to antihypertensive medications between ethnic groups, but ethnicity seems to be less important as a determinant of clinical outcomes. In this Review we examine key ethnic variations in hypertensive CKD in terms of pathophysiology, response to antihypertensive therapy, clinical outcomes, and evidence-based recommendations for blood-pressure control, with an emphasis on African Americans.Nature Clinical Practice Nephrology 09/2008; 4(10):538-49. · 6.08 Impact Factor -
Article: The relative risk of cardiovascular death among racial and ethnic minorities with metabolic syndrome: data from the NHANES-II mortality follow-up.
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ABSTRACT: The tendency for selected cardiovascular disease (CVD) risk factors to occur in clusters has led to the description of metabolic syndrome (MetS). The relative impact of the individual risk factor on the overall relative risk (RR) for cardiovascular death from metabolic syndrome is not well established and may differ across the different racial/ethnic groups. Using data from the National Health and Nutrition Examination Survey (NHANES II) mortality follow-up (NH2MS), we determined the prevalence and RR of cardiovascular death for individual components in the overall population and across racial and ethnic groups. The prevalence of MetS components varied significantly across gender and racial/ethnic groupings. The RR for CVD also varies for the number and different components of MetS. The adjusted RR for cardiovascular death was highest with diabetes (3.23; 95% CI: 2.70-3.88), elevated blood pressure (2.28; 95% CI: 1.94-2.67) and high triglycerides (1.63; 95% CI: 1.34-2.00). Although the RR for cardiovascular death differs significantly for some of the different components, the overall findings were similar across racial/ethnic groups. The two components that confer the highest risks for death are more prevalent in African Americans. We concluded that the RR of cardiovascular death associated with the diagnosis of MetS varies depending on the number and components used to establish the diagnosis of MetS and the racial/ethnic characteristic of the participants.Journal of the National Medical Association 06/2008; 100(5):565-71. · 1.16 Impact Factor -
Article: Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey.
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ABSTRACT: Results of several epidemiologic and clinical studies have suggested that there is an excess risk of hypertension and diabetes mellitus in persons with suboptimal intake of vitamin D. We examined the association between serum levels of 25-hydroxyvitamin D (25[OH]D) and select cardiovascular disease risk factors in US adults. A secondary analysis was performed with data from the Third National Health and Nutrition Examination Survey, a national probability survey conducted by the National Center for Health Statistics between January 1, 1988, and December 31, 1994, with oversampling of persons 60 years and older, non-Hispanic black individuals, and Mexican American individuals. There were 7186 male and 7902 female adults 20 years and older with available data in the Third National Health and Nutrition Examination Survey. The mean 25(OH)D level in the overall sample was 30 ng/mL (75 nmol/L). The 25(OH)D levels were lower in women, elderly persons (>or=60 years), racial/ethnic minorities, and participants with obesity, hypertension, and diabetes mellitus. The adjusted prevalence of hypertension (odds ratio [OR], 1.30), diabetes mellitus (OR, 1.98), obesity (OR, 2.29), and high serum triglyceride levels (OR, 1.47) was significantly higher in the first than in the fourth quartile of serum 25(OH)D levels (P<.001 for all). Serum 25(OH)D levels are associated with important cardiovascular disease risk factors in US adults. Prospective studies to assess a direct benefit of cholecalciferol (vitamin D) supplementation on cardiovascular disease risk factors are warranted.Archives of Internal Medicine 06/2007; 167(11):1159-65. · 11.46 Impact Factor -
Article: The association of poverty with the prevalence of albuminuria: data from the Third National Health and Nutrition Examination Survey (NHANES III).
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ABSTRACT: Albuminuria is a major risk factor for the development and progression of chronic kidney disease (CKD) and cardiovascular disease. Socioeconomic factors also have been reported to modify CKD and cardiovascular risk factors and clinical outcomes. The extent to which poverty influences the prevalence of albuminuria, particularly among racial/ethnic minority populations, is not well established. The influence of poverty on the prevalence of albuminuria and the implication of this relationship for the racial and/or ethnic differences in the prevalence of albuminuria were examined. We examined data from 6,850 male and 7,634 female adults from a national probability survey conducted between 1988 and 1994. In univariate analysis, poverty, defined as less than 200% federal poverty level (FPL), was associated with the presence of both microalbuminuria (odds ratio [OR], 1.35; 95% confidence interval, 1.22 to 1.49) and macroalbuminuria (OR, 1.78; 95% confidence interval, 1.40 to 2.26). The association of less than 200% FPL with microalbuminuria persisted in a multivariate model controlling for age, sex, race, education, obesity, hypertension, diabetes, reduced glomerular filtration rate, and medication use (OR, 1.18; 95% confidence interval, 1.05 to 1.33). FPL less than 200% was not associated with macroalbuminuria in the multivariate model. When multivariate analysis is stratified by FPL (<200% and > or =200%), differences in ORs for microalbuminuria and macroalbuminuria among racial/ethnic minority participants compared with whites were more apparent among the less affluent participants in the FPL-less-than-200% stratum. FPL less than 200% is associated with microalbuminuria, and differences in FPL levels may account for some of the observed differences in prevalence of albuminuria between racial/ethnic minority participants and their white counterparts.American Journal of Kidney Diseases 06/2006; 47(6):965-71. · 5.43 Impact Factor -
Article: Management of early chronic kidney disease in indigenous populations and ethnic minorities.
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ABSTRACT: The rate of treated end-stage renal disease (ESRD) continues to increase globally. The disproportionately high rate of ESRD among the many growing indigenous populations and racial/ethnic minorities in the United States highlights the need to reassess present treatment strategies to more appropriately identify and manage chronic kidney disease in diverse communities. Similar projections have been noted worldwide. This discrepancy between ESRD rates among racial and ethnic minority groups, and treatment strategies is due to several factors, many of which are modifiable. These include the individual, the health care provider/system, and limited participation in controlled clinical trials. Although it is unfortunate that this disparity continues to exist, a thoughtful and compassionate approach to addressing the role of diverse biobehavioral and sociocultural factors might be the key to effective translation of emerging scientific advances into improved clinical outcomes for all patients with chronic kidney disease.Kidney international. Supplement 09/2005; -
Article: Chronic kidney disease in African American and Mexican American populations.
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ABSTRACT: African Americans and Mexican Americans suffer from disproportionately high rates of end-stage renal disease in comparison with whites from the United States. An improved understanding of both classic and novel chronic kidney disease risk factors among racial/ethnic minorities may help to facilitate improved prevention, screening, and early intervention strategies for all patients at risk for chronic kidney disease-not only in the United States, but on a global level. The economic implications are equally important to inform health policy recommendations and ensure cost-effective allocation of limited resources.Kidney international. Supplement 09/2005; -
Article: Sodium disorders in the elderly.
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ABSTRACT: Disorders of sodium imbalance are commonly encountered in clinical practice and can have a substantial impact on the prognosis of the patient. These disorders are more common in the elderly. Sodium disorders can cause serious neurologic symptoms and even death, particularly among hospitalized patients. The identification of sodium abnormalities and appropriate clinical intervention are critical for improving patient outcomes. Early recognition of hyponatremia and hypernatremia can provide a clue to an underlying disorder. In this update, we have summarized age-related homeostatic changes that impair sodium balance, medications that alter salt and water handling, and the recognition and management of sodium disorders in elderly patients.Journal of the National Medical Association 03/2005; 97(2):217-24. · 1.16 Impact Factor -
Article: The prevalence of hypovitaminosis D among US adults: data from the NHANES III.
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ABSTRACT: Several epidemiologic and mechanistic studies suggest that 25(OH) D3 levels should be maintained above 70 nmol/L for a positive effect on the health of adults. Prior studies have noted low 25(OH) D3 levels in subsets of minority populations. The objective of this study is to examine the prevalence of adequate 25(OH) D3 levels among US adults. Using data from the third National Health and Nutrition Examination Survey (NHANES III), we evaluated serum levels of 25(OH) D3 (nmol/L) among 15,390 adult participants > or = 18 years of age. Racial/ethnic grouping was by self-identification as White, Black or African American, and Hispanic. The mean levels of 25(OH) D3 were lower among the female than male participants (71.1 vs 78.7; P=.003) and among the elderly (> or = 65 years of age vs 40-59 and 18-39) than young participants. White men and women (83.0 and 76.0) had higher mean levels of vitamin D than Hispanic men and women (68.3 and 56.7; P<.0001) and than Black men and women (52.2 and 45.3; P<.0001), respectively. The prevalence of both mild-moderate and severe deficiency of vitamin D is higher among women (P<.0001) and minority populations (P<.0001). However, even among White men, 34% had low vitamin D levels. Serum levels of 25(OH) D3 are below the recommended levels for a large portion of the general adult population and in most minorities. Need exists for a critical review and probable revision of current recommendations for adult vitamin D intake to maintain adequate 25(OH) D3 levels.Ethnicity & disease 01/2005; 15(4 Suppl 5):S5-97-101. · 0.90 Impact Factor -
Article: The impact of routine vitamin supplementation on serum levels of 25 (OH) D3 among the general adult population and patients with chronic kidney disease.
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ABSTRACT: Vitamin D supplementation is recommended to maintain bone health in the general population and in particular in patients with chronic kidney disease (CKD). While the nutritional status of vitamin D is assessed by circulating levels of 25 (OH) D3, it is not routinely measured to ensure the adequacy of vitamin D supplementation. Current recommendations require the maintenance of serum levels of 25 (OH) D3 > or = 70 nmol/L. The objective of this study is to assess the effect of routine vitamin supplements on the serum levels of 25 (OH) D3 in the general population and among persons with CKD. Using data from the third National Health and Nutrition Examination Survey (NHANES III) we assessed the adequacy of routine vitamin supplementation by assessing serum levels of 25 (OH) D3 among 15,390 adult participants, both with and without CKD. In the general population the participants with vitamin supplements had higher serum level of 25 (OH) D3 (79.47 vs 74.38 nmol/L) and a lower prevalence of vitamin D deficiency (39% vs 48%) than participants not taking any supplements. In the CKD subgroup, the prevalence of vitamin D deficiency was lower with supplements (49%), while greater without supplements (59%). Vitamin D deficiency was higher among women, elderly, and minorities as previously reported. In an adjusted regression model the odds of severe vitamin D deficiency (<25 nmol/L) was 1.43 (P=.0032) among CKD patients, with a trend toward higher rates among patients not taking vitamin supplements (odds ratio 1.47, P=.0557). Vitamin supplementation is associated with a lower prevalence of vitamin D deficiency and higher serum levels of 25 (OH) D3. However, the current dose of vitamin D in routine vitamin supplements is still insufficient to maintain adequate serum 25 (OH) D3 levels in a substantial portion of both the general and CKD populations. We must re-asses the dose of vitamin D in routine vitamin supplements in the United States.Ethnicity & disease 01/2005; 15(4 Suppl 5):S5-102-6. · 0.90 Impact Factor -
Article: Hypertension treatment in African Americans: physiology is less important than sociology.
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ABSTRACT: African Americans have higher rates of hypertension and its complications than do people of other ethnic groups, and they may respond differently to various antihypertensive drugs. Social, cultural, and economic barriers to care are probably more important than any true physiologic differences between races.Cleveland Clinic Journal of Medicine 10/2004; 71(9):735-43. · 3.77 Impact Factor -
Article: Alterations in acid-base homeostasis with aging.
Journal of the National Medical Association 08/2004; 96(7):921-5; quiz 925-6. · 1.16 Impact Factor -
Article: Education, motivation and medication for African Americans: bringing hypertension guidelines to practice.
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ABSTRACT: African Americans suffer from high rates of hypertension and hypertension-related complications. While racial/ethnic differences in blood pressure response to pharmacologic therapy have been described, most randomized hypertension trials with substantial enrollment of African Americans receiving standardized medical care do not support class-specific racial/ethnic differences in key clinical outcomes. Understanding health care systems and the socio-economic and demographic factors that impair access can enhance the ability of the provider to enlist and engage the patient for optimal blood pressure control and end organ protection.Ethnicity & disease 02/2004; 14(4):S2-38-41. · 0.90 Impact Factor -
Article: Calcium antagonists: a more expansive role in treating persons with reduced kidney function?
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ABSTRACT: Most recent studies have supported inhibition of the renin-angiotensin-aldosterone system (RAAS) with diuretic as initial hypertensive therapy in patients with chronic kidney disease (CKD). The recommended role of calcium channel blockers (CCB) in CKD patients had diminished due to class-specific differences in antiproteinuric effects and lesser efficacy in reducing composite renal clinical outcomes when compared to RAAS inhibition. However, the demonstrated safety and efficacy of CCB in combination with RAAS inhibition, and the recognized need for effective antihypertensive agents to achieve the low target blood pressures, has prompted a more expanded use of calcium channel blockers in this difficult to treat CKD population.Ethnicity & disease 02/2004; 14(4):S2-42-5. · 0.90 Impact Factor
Top co-authors
Top Journals
Institutions
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2004–2012
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Charles R. Drew University of Medicine and Science
- • Internal Medicine
- • Department of Medicine
Los Angeles, CA, USA -
VA Greater Los Angeles Healthcare System
Los Angeles, CA, USA
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2009
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Los Angeles Biomedical Research Institute
- Department of Medicine
Torrance, CA, USA
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2000–2005
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University of California, Los Angeles
Los Angeles, CA, USA
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