Elizabeth A Jackson

University of Michigan, Ann Arbor, Michigan, United States

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Publications (49)221.62 Total impact

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    ABSTRACT: Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3mg/l, a level of clinical significance. We found strong associations between PM2.5 and CRP among several subgroups. For example a 10µg/m(3) increase in annual PM2.5 more than doubled the risk of CRP greater than 3mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
    Environmental Research 04/2014; 132C:168-175. · 3.24 Impact Factor
  • The American journal of medicine 01/2014; · 5.30 Impact Factor
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    ABSTRACT: Objectives We sought to examine gender-related differences in outcomes related to PVI procedures. Background Percutaneous peripheral vascular intervention (PVI) is frequently performed for the treatment of peripheral arterial disease (PAD). However, little is known about gender-related differences related to PVI procedures. Methods We assessed the impact of gender among 12,379 patients (41% female) who underwent lower extremity (LE)-PVI from 2004 to 2009 at 16 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry. Multivariate propensity matched analyses were performed to adjust for differences in baseline characteristics, procedural indications and comorbidities based on gender. Results Compared with males, females were older, have multilevel disease and critical limb ischemia. In a propensity-matched analysis, female sex was associated with a higher rate of vascular complications, transfusions, and embolism. No differences were observed for in-hospital death, myocardial infarction or stroke/transient ischemic attack. Technical success was more commonly achieved in females (91.2% vs. 89.1%, p=0.014) but due to a higher complication rate, the overall procedural success rates were similar in men and women (79.7% vs. 81.6%, p=0.08). Conclusions Females represent a significant proportion of patients undergoing LE-PVI, have more severe and complex disease process, and are at increased risk for adverse outcomes. Despite higher complications rates, females had similar procedural success compared with men, making PVI an effective treatment strategy among women LE-PAD.
    Journal of the American College of Cardiology 01/2014; · 14.09 Impact Factor
  • Paolo Giorgini, Alan B. Weder, Elizabeth A. Jackson, Robert D. Brook
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    ABSTRACT: Background Hypertension guidelines recommend following published standardized protocols to obtain accurate blood pressure (BP) readings in clinical practice. However, the various measurement techniques among clinical trials that provide the basis for evidence-based management have not been evaluted or compared to guideline recommendations. Methods We reviewed published information regarding BP measurement in clinical trials (n=64) from 1990-2014 by searching PubMed and Google Scholar databases. Results Every trial failed to provide published information regarding at least one of the 10 methodological aspects we evaluated. Details regarding the healthcare provider(s) performing measurement(s), temporal-relation to last medication dosage, number of readings, resting time before (and between recordings), and the device(s) employed varied amongst the trials and often differed from clinical recommendations. Most studies did evaluate ≥2 BP readings in a seated position, presumably from the upper arm (though explicit acknowledgement of this latter detail was rare). When indicated, “trough” BP levels were most commonly obtained (15/16 trials), while the usage of automated devices increased over time. Conclusions Numerous aspects of BP measurement varied considerably across trials and often from most recent guideline recommendations. The lack of uniform methodologies in outcome studies that form the foundation of evidence-based guidelines may have significant clinical implications.
    Journal of the American Society of Hypertension. 01/2014;
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    ABSTRACT: Background Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
    Environmental Research. 01/2014; 132:168–175.
  • Douglas Darden, Caroline Richardson, Elizabeth A. Jackson
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    ABSTRACT: Most adults do not achieve the recommended levels of physical activity, including patients with cardiovascular disease (CVD). Furthermore, healthcare providers often do not understand the benefits of physical activity in CVD patients, rather over emphasizing the potential risks related to activity. Recent studies suggest reductions in cardiovascular events including mortality with concomitant improvements in quality of life for many vascular conditions. However gaps in our current knowledge base remain. Recent research on physical activity including use of novel internet based interventions are developing areas of interest have moved to reduce such knowledge gaps.
    Current Cardiovascular Risk Reports 12/2013; 7(6).
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    ABSTRACT: To test whether the number of teeth, an inverse proxy for composite oral infection scores is associated with better survival. The Kuopio Oral Health and Heart study initiated a case-control study in 1995-1996 consisting of 256 consecutive coronary artery disease patients and 250 age and gender-matched controls. We appended the mortality data and formulated a longitudinal study. By May 31st, 2011, 124 mortalities had occurred and 80 of which were of cardiovascular origin. Using Cox proportional hazards models, we assessed the association of the teeth group (Teethgrp) - consisting of 10 teeth - with cardiovascular and all-cause mortality after 15.8 years of median follow-up. In multivariate models, with the edentulous state as reference, one level increase in Teethgrp was associated with significantly increased survival from cardiovascular disease (CVD) mortality with a Hazard Ratio (HR) 0.73, p-value = 0.02 but not with all-cause mortality (HR = 0.87, p = 0.13). The findings were not mediated by C-reactive protein (CRP) levels ≥3 mg/L or by median fibrinogen levels, but were mediated by CRP levels >5 mg/L. Each increment of 10 teeth from the edentulous state was associated with a 27% improved CVD survival, independent of low-grade systemic inflammation.
    Journal Of Clinical Periodontology 11/2013; · 3.69 Impact Factor
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    ABSTRACT: To examine factors associated with low high-density lipoprotein cholesterol (HDL-C) levels among middle school children. HDL-C levels were the primary outcome of interest. A total of 1,104 middle-school children (mean age 11.6 years, 51.2 % female) were included in this analysis, of whom 177 (16 %) had an HDL-C level ≤40 mg/dL. More than half of those with low HDL-C were overweight or obese (62.2 %) and had greater systolic and diastolic blood pressure, triglyceride (TRG) levels, and low-density lipoprotein cholesterol levels compared with children with an HDL-C level >40 mg/dL. Among those with an HDL-C ≤ 40 mg/dL, 35 % also had body mass index ≥85 % and TRG levels ≥150 mg/dL. Exercise habits were significantly associated with HDL-C level, whereas sedentary behaviors, such as screen time, were not significantly associated with HDL-C level. Fruit and vegetable intake was also not significantly associated with HDL-C level. Children with low HDL-C levels are more likely to be overweight and to have other physiological indicators of increased cardiovascular risk. Further research is needed to determine if school-based interventions can result in long-term improvements in HDL-C.
    Pediatric Cardiology 10/2013; · 1.20 Impact Factor
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    ABSTRACT: BACKGROUND:Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention.METHODS:Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ(2) analysis. Univariate associations with P < .10 were included in a stepwise logistic regression model to determine independent predictors for obesity by gender.RESULTS:Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01-1.64; OR 1.27, 95% CI 1.00-1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07-1.32; OR 1.19, 95% CI 1.06-1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82-0.98; OR 0.77, 95% CI 0.64-0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67-0.98).CONCLUSIONS:Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.
    PEDIATRICS 08/2013; · 4.47 Impact Factor
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    ABSTRACT: This study aimed to measure the impact of a school-based multidisciplinary intervention program on risk factors for atherosclerosis in sixth-grade middle school students. We also measured health behaviors before and after the intervention using a validated questionnaire. A prospective study was performed in which students served as historical controls. Sixth-grade students from 23 middle schools in 12 cities with varying populations were exposed to a program promoting healthful activity and nutrition habits through educational and environmental change. Along with a modified School-Based Nutrition Monitoring behavioral questionnaire, physiologic risk factors were studied, including body mass index, systolic and diastolic blood pressures, cholesterol panel, and random blood glucose, which were measured before the 10-week program and again 1 to 3 months after program completion. Of 4021 sixth graders (male, 49%) at 23 middle schools completing a before and after behavioral survey, 2118 students, aged 11.56 ± 0.47 years, consented to participate in the screening. The mean total cholesterol value decreased from 161.64 ± 28.99 mg/dL to 154.77 ± 27.26 mg/dL (P < .001). The low-density lipoprotein value decreased from 89.37 ± 25.08 mg/dL to 87.14 ± 24.25 mg/dL (P < .001). The high-density lipoprotein value decreased from 52.15 ± 13.35 md/dL to 49.95 ± 13.28 mg/dL (P < .001). The measure of triglycerides decreased from 113.34 ± 73.19 mg/dL to 101.22 ± 63.93 mg/dL (P < .001). The random glucose value decreased from 97.51 ± 16.00 to 94.94 ± 16.62 (P < .001). The mean systolic blood pressure decreased from 109.47 ± 15.26 mm Hg to 107.76 ± 10.87 mm Hg (P < .001), and the mean diastolic blood pressure decreased from 64.78 ± 8.57 mm Hg to 63.35 ± 7.81 mm Hg (P < .001). These changes in physiologic measures seemed to correlate with self-reported increases in vegetable and fruit consumption, increases in physical activity, and less screen time. Project Healthy Schools, a middle school intervention to improve childhood cardiovascular risk factors, is feasible and seems to be effective. The results showed significant improvements in risk factors associated with early atherosclerosis among sixth-grade students, including total cholesterol, low-density lipoprotein cholesterol, triglycerides, and systolic and diastolic blood pressures. Further study with a larger group of students and a longer follow-up period would be valuable.
    The American journal of medicine 08/2013; · 5.30 Impact Factor
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    ABSTRACT: OBJECTIVE: The relatively modest benefit of vasomotor symptom relief in clinical trials of isoflavones may reflect once-daily dosing and low percentages of participants who are able to metabolize daidzein into equol, a potentially more biologically active isoflavone. This pilot study examined whether symptom reduction was greater with more frequent administration and with higher daily doses. In addition, we explored possible effect modification by equol producer status. METHODS: We randomized 130 perimenopausal (no menses in the past 3 mo) and postmenopausal (≥12 mo of amenorrhea) women with a mean of five or more moderate/severe hot flashes per day to treatment arms with varying total daily isoflavone doses and dosing frequency, separately for equol producers and nonproducers. Participants recorded the daily frequency and severity of hot flashes. Analyses compared mean daily hot flash intensity scores (sum of hot flashes weighted by severity) by total daily dose and by dosing frequency. Dose- and frequency-related differences were also compared for equol producers and nonproducers. RESULTS: Hot flash intensity scores were lowest in women randomized to the highest total daily dose (100-200 mg) and in women randomized to the highest dosing frequency (twice daily to thrice daily), with greater benefits on nighttime scores than on daytime scores. Dose- and frequency-related differences were somewhat larger in equol producers than in nonproducers. CONCLUSIONS: These results suggest that a twice-daily to thrice-daily dosing frequency may improve the benefit of isoflavones for vasomotor symptom relief, particularly in equol producers and for nighttime symptoms. Larger studies are needed to confirm these findings.
    Menopause (New York, N.Y.) 03/2013; · 3.08 Impact Factor
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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; · 1.20 Impact Factor
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    ABSTRACT: Over the past three decades the proportion of students classified as overweight has almost tripled. This trend in childhood obesity is a cause for concern. Stakeholders have come together to stem growth and implement healthy habits in childhood to not only prevent obesity, but also future cardiovascular risk. School-based health interventions have proven to be an effective medium to reach youth. Sustainable practices remain the largest determinant of long-term success of these programs. Project Healthy Schools, a community–university collaborative school-based health intervention program, sustainable practices have led to positive changes in participating middle schools. This collaborative has provided important insight on key factors needed for long-term sustainability for a school-based wellness program. These key factors are described under leadership, policy, finances, and reproducibility. Future school-based programs may plan for success with sustainability while drawing from our experience.
    World Medical & Health Policy. 12/2012; 4(3-4).
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    ABSTRACT: Understanding childhood obesity's root causes is critical to the creation of strategies to improve our children's health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity. We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income. In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down. The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.
    American heart journal 05/2012; 163(5):836-43. · 4.65 Impact Factor
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    ABSTRACT: The school environment has been the focus of many health initiatives over the years as a means to address the childhood obesity crisis. The availability of low-nutrient, high-calorie foods and beverages to students via vending machines further exacerbates the issue of childhood obesity. However, a healthy overhaul of vending machines may also affect revenue on which schools have come to depend. This article describes the experience of one school district in changing the school environment, and the resulting impact on food and beverage vending machines. Observational study in Ann Arbor public schools. The contents and locations of vending machines were identified in 2003 and surveyed repeatedly in 2007. Overall revenues were also documented during this time period. Changes were observed in the contents of both food and beverage vending machines. Revenue in the form of commissions to the contracted companies and the school district decreased. Local and national wellness policy changes may have financial ramifications for school districts. In order to facilitate and sustain school environment change, all stakeholders, including teachers, administrators, students and healthcare providers, should collaborate and communicate on policy implementation, recognizing that change can have negative financial consequences as well as positive, healthier outcomes.
    Public health 02/2012; 126(4):335-7. · 1.26 Impact Factor
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    ABSTRACT: Several medications have individually been shown to reduce mortality in patients with acute coronary syndromes (ACS), but data on long-term outcomes related to the use of combinations of these medications are limited. For 2,684 consecutive patients admitted with ACS from January 1999 and January 2007, a composite score was calculated correlating with the use upon discharge of indicated evidence-based medications (EBMs): aspirin, β blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents. Multivariate models were used to examine the impact of EBM score on 2-year events with adjustment for components of the Global Registry of Acute Coronary Events (GRACE) risk score, thienopyridine use, and year of discharge. Women were older, had more co-morbidities, and were less likely to receive all 4 EBMs (53% vs 64%, p < 0.0001) than men. Patients who received all 4 indicated EBMs had a significant 2-year survival benefit compared to patients who received ≤1 EBM (odds ratio 0.25, 95% confidence interval 0.15 to 0.41), which was observed when men and women were examined separately (for men, odds ratio 0.22, 95% confidence interval 0.11 to 0.44; for women, odds ratio 0.3, 95% confidence interval 0.15 to 0.63). A modest benefit, in terms of cardiovascular disease events (myocardial infarction, rehospitalization, stroke, and death), was observed only for men who received all 4 EBMs. In conclusion, a combination of cardiac medications at the time of ACS discharge is strongly associated with 2-year survival in men and women, suggesting that discharge is an important time to prescribe secondary preventative medications.
    The American journal of cardiology 01/2012; 109(2):159-64. · 3.58 Impact Factor
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    ABSTRACT: Lipoprotein (a) [Lp(a)] has a strong association with coronary disease (CHD). We evaluated the implications of implementing a niacin strategy in persons above low risk by the Framingham risk score (FRS). Patients referred to a university lipid management program from January 2004 to June 2010 had an Lp(a) level measured at initial evaluation. Factors associated with an increase in Lp(a) and predictors of a high risk Lp(a) (≥50 mg/dL) were assessed. FRS and Lp(a) levels were used to assess eligibility for niacin with an Lp(a) ≥50 mg/dL. A total of 692 patients (57% male, mean age 52 ± 14 years) had a mean Lp(a) of 32 ± 40 mg/dL. In a multiple logistic regression model, African-American race, female gender, presence of CHD, and lower triglyceride levels were significant predictors of high risk Lp(a). Ten percent were determined to be intermediate and 44% high risk by FRS. A total of 9% of intermediate- and 26% of high-risk patients had an Lp(a) ≥50 mg/dL, and 84% were not taking niacin. A total of 19% of moderate- and high-risk patients were eligible for initiation of niacin based upon values ≥50 mg/dL. If niacin were also used for an high-density lipoprotein cholesterol levels ≤40 mg/dL, only 5.1% additional patients would require niacin. High-risk levels of Lp(a) are associated with female gender, African- American race, and CHD. 19% of moderate and high risk patients would be candidates for treatment with niacin if the indication is a cutpoint Lp(a) ≥50 mg/dL.
    Journal of Clinical Lipidology 01/2012; 6(1):66-73. · 3.59 Impact Factor
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    ABSTRACT: Physicians' personal health habits are associated with their counseling habits regarding physical activity. We sought to examine physicians' own barriers to a healthy lifestyle by level of training and gender. Physicians at a major teaching hospital were surveyed regarding their lifestyle habits and barriers to healthy habits. The frequency of reported barriers was examined by years in practice (trainees vs staff physicians) and gender. 183 total responses were received. Over 20% of respondents were overweight. Work schedule was cited as the greatest barrier to regular exercise in 70.5% of respondents. Trainees were more likely to cite time constraints or cost as a barrier to a healthy diet compared to staff physicians. Staff physicians were more likely to report the time to prepare healthy foods as a barrier. For both trainees and staff physicians, time was a barrier to regular exercise. For trainees work schedule was a barrier, while both work schedule and family commitments were top barriers cited by staff physicians. Women were more likely to report family commitments as a barrier than men. Respondents suggested healthier options in vending machines and the hospital cafeteria, healthy recipes, and time and/or facilities for exercise at work as options to help overcome these barriers. Work schedules and family commitments are frequently reported by providers as barriers to healthy lifestyle. Efforts to reduce such barriers may lead to improved health habits among providers.
    International Journal of General Medicine 01/2012; 5:53-7.
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    ABSTRACT: We sought to examine factors associated with depressive symptoms among patients with heart disease. Data from 197 patients admitted for coronary artery disease were examined using multivariate predictive models. Women and unmarried patients were more likely to report depressive symptoms. In multivariate models, we observed that depressive symptoms were associated with the level of tangible social (but not emotional) support, bodily pain, and vitality, but not the number of comorbidities, gender, or marital status.
    Clinical Epidemiology 01/2012; 4:181-6.
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    ABSTRACT: Cigarette smoking has been associated with lower mortality after an acute coronary event. We hypothesized that the improved survival in smokers is related to demographic differences and sought to further evaluate the gender disparities in smokers after an acute coronary event. A prospective cohort of 3,588 patients hospitalized at a single center from 1999 to 2006 was identified. Smoking status, in-hospital and 6-month follow-up death, and cardiovascular events (i.e., myocardial infarction, stroke, cardiac-related rehospitalization, and unscheduled revascularization) were assessed. The prevalence of smoking in men increased over time. The smokers were younger at presentation with fewer co-morbidities than nonsmokers. Male smokers had lower mortality (3.2% vs 5.4%, p = 0.04) and fewer cardiovascular events (33.1% vs 42.4%, p = 0.003) at 6 months than nonsmokers. However, after adjusting for age and co-morbidities, smoking was not an independent predictor of events (odds ratio 0.88, 95% confidence interval 0.67 to 1.17). Female smokers had mortality (5.6% vs 8.4%, p = 0.15) and cardiovascular events (54.5% vs 49.7%, p = 0.28) at 6 months similar to that of nonsmokers, with a nonsignificant trend toward increased risk after adjustment (odds ratio 1.31, 95% confidence interval 0.90 to 1.93). Among smokers, female gender remained a significant risk factor for cardiovascular events at 6 months (odds ratio 2.35, 95% confidence interval 1.58 to 3.50), even after adjustment for age and co-morbidities. In conclusion, smokers experienced acute coronary event events earlier than did nonsmokers. Younger age and fewer co-morbidities likely account for most observed survival benefit in smokers, although female smokers are more likely to experience cardiovascular complications by 6 months than male smokers.
    The American journal of cardiology 09/2011; 108(10):1382-6. · 3.58 Impact Factor

Publication Stats

120 Citations
221.62 Total Impact Points

Institutions

  • 2009–2014
    • University of Michigan
      • • Division of Cardiovascular Medicine
      • • Department of Internal Medicine
      Ann Arbor, Michigan, United States
  • 2009–2013
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2012
    • Wayne State University
      Detroit, Michigan, United States
  • 2010
    • Dartmouth–Hitchcock Medical Center
      Lebanon, New Hampshire, United States
    • Michigan State University
      • Department of Medicine
      East Lansing, MI, United States