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  1. Article ; Online: Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future.

    Johnson, Amber E / Talabi, Mehret Birru / Bonifacino, Eliana / Culyba, Alison J / Davis, Esa M / Davis, Paula K / De Castro, Laura M / Essien, Utibe R / Maria Gonzaga, Alda / Hogan, MaCalus V / James, Alaina J / Jonassaint, Charles R / Jonassaint, Naudia L / Matheo, Loreta / Nance, Melonie A / Napoé, G Sarah / Olafiranye, Oladipupo / Owusu-Ansah, Sylvia / Pierson-Brown, Tomar N /
    Conrad Smith, A J / Suber, Tomeka L / Torres, Orquidia / Tripp, Rickquel / Ufomata, Eloho / Wilson, J Deanna / South-Paul, Jeannette E

    Circulation

    2021  Volume 143, Issue 24, Page(s) 2395–2405

    Abstract: In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular ...

    Abstract In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.
    MeSH term(s) Cardiologists/statistics & numerical data ; Female ; Health Equity ; Humans ; Male ; Racial Groups ; United States ; Workforce
    Language English
    Publishing date 2021-06-14
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.121.053566
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Assessment of P2Y12 inhibitor usage and switching in acute coronary syndrome patients undergoing percutaneous coronary revascularization.

    Kudaravalli, Mrudula / Althouse, Andrew D / Marroquin, Oscar C / Khandhar, Sameer J / Sharbaugh, Michael S / Toma, Catalin / Conrad Smith, A J / Schindler, John T / Lee, Joon S / Mulukutla, Suresh R

    International journal of cardiology

    2016  Volume 223, Page(s) 854–859

    Abstract: Background: Dual antiplatelet therapy is recommended for patients with acute coronary syndrome (ACS) that undergo percutaneous coronary intervention (PCI). However, the effect of switching P2Y12 inhibitors between the loading dose and therapy after ... ...

    Abstract Background: Dual antiplatelet therapy is recommended for patients with acute coronary syndrome (ACS) that undergo percutaneous coronary intervention (PCI). However, the effect of switching P2Y12 inhibitors between the loading dose and therapy after discharge is not well described.
    Methods: This post-hoc analysis of a prospectively collected registry included 3219 consecutive ACS patients who underwent PCI. Patients were categorized into four groups: clopidogrel at load and discharge (C-C), loading dose of clopidogrel and discharged on prasugrel/ticagrelor (C-PT), loading dose of prasugrel/ticagrelor and discharged on clopidogrel (PT-C), and prasugrel/ticagrelor at load and discharge (PT-PT).
    Results: While 77.6% of patients received the C-C treatment regimen and 13.6% received the PT-PT strategy, the strategy of P2Y12 switching was fairly common with 6.2% in the PT-C group and 2.6% in the C-PT group. While C-C was the most common treatment regimen, PT-C and PT-PT were more commonly used in STEMI patients than in NSTEMI or unstable angina patients. A significantly lower unadjusted incidence of the composite outcome (death, MI, and repeat revascularization) was appreciated in both the PT-C (1.0%) and PT-PT (2.3%) groups than the C-C group (4.0%). Propensity-score matched analysis still showed significantly reduced risk (HR=0.22, 95% CI 0.05-0.93, p=0.04) in the PT-C group vs. a matched group of C-C controls.
    Conclusions: The strategy of utilizing a newer P2Y12 inhibitor and then switching to clopidogrel in ACS patients following PCI is used with some frequency in routine clinical practice and further studies should evaluate the safety and efficacy of such a strategy.
    MeSH term(s) Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/epidemiology ; Acute Coronary Syndrome/surgery ; Adenosine/administration & dosage ; Adenosine/adverse effects ; Adenosine/analogs & derivatives ; Aftercare/methods ; Clopidogrel ; Dose-Response Relationship, Drug ; Drug Substitution/methods ; Drug Therapy, Combination/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Medication Therapy Management/organization & administration ; Middle Aged ; Percutaneous Coronary Intervention/methods ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects ; Prasugrel Hydrochloride/administration & dosage ; Prasugrel Hydrochloride/adverse effects ; Purinergic P2Y Receptor Antagonists/administration & dosage ; Purinergic P2Y Receptor Antagonists/adverse effects ; Registries ; Ticagrelor ; Ticlopidine/administration & dosage ; Ticlopidine/adverse effects ; Ticlopidine/analogs & derivatives ; Treatment Outcome ; United States/epidemiology
    Chemical Substances Platelet Aggregation Inhibitors ; Purinergic P2Y Receptor Antagonists ; Clopidogrel (A74586SNO7) ; Prasugrel Hydrochloride (G89JQ59I13) ; Ticagrelor (GLH0314RVC) ; Adenosine (K72T3FS567) ; Ticlopidine (OM90ZUW7M1)
    Language English
    Publishing date 2016-08-08
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2016.08.144
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1673: Show issues Location:
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  3. Article: Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study.

    Reis, S E / Holubkov, R / Conrad Smith, A J / Kelsey, S F / Sharaf, B L / Reichek, N / Rogers, W J / Merz, C N / Sopko, G / Pepine, C J

    American heart journal

    2001  Volume 141, Issue 5, Page(s) 735–741

    Abstract: Background: Chest pain in the absence of obstructive coronary artery disease (CAD) is common in women; it is frequently associated with debilitating symptoms and repeated evaluations and may be caused by coronary microvascular dysfunction. However, the ... ...

    Abstract Background: Chest pain in the absence of obstructive coronary artery disease (CAD) is common in women; it is frequently associated with debilitating symptoms and repeated evaluations and may be caused by coronary microvascular dysfunction. However, the prevalence and determinants of microvascular dysfunction in these women are uncertain.
    Methods: We measured coronary flow velocity reserve (coronary velocity response to intracoronary adenosine) to evaluate the coronary microvasculature and risk factors for atherosclerosis in 159 women (mean age, 52.9 years) with chest pain and no obstructive CAD. All women were referred for coronary angiography to evaluate their chest pain as part of the Women's Ischemia Syndrome Evaluation (WISE) study.
    Results: Seventy-four (47%) women had subnormal (<2.5) coronary flow velocity reserve suggestive of microvascular dysfunction (mean, 2.02 +/- 0.38); 85 (53%) had normal reserve (mean, 3.13 +/- 0.64). Demographic characteristics, blood pressure, ventricular function, lipid levels, and reproductive hormone levels were not significantly different between women with normal and those with abnormal microvascular function. Postmenopausal hormone use within 3 months was significantly less prevalent among those with microvascular dysfunction (40% vs 60%, P =.032). Age and number of years past menopause correlated with flow velocity reserve (r = -0.18, P =.02, and r = -0.30, P <.001, respectively). No significant associations were identified between flow velocity reserve and lipid and hormone levels, blood pressure, and left ventricular ejection fraction.
    Conclusions: Coronary microvascular dysfunction is present in approximately one half of women with chest pain in the absence of obstructive CAD and cannot be predicted by risk factors for atherosclerosis and hormone levels. Therefore, the diagnosis of coronary microvascular dysfunction should be considered in women with chest pain not attributable to obstructive CAD.
    MeSH term(s) Blood Flow Velocity ; Cardiac Catheterization ; Cardiotonic Agents ; Chest Pain/blood ; Chest Pain/diagnosis ; Chest Pain/epidemiology ; Chest Pain/physiopathology ; Cholesterol/blood ; Coronary Angiography ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/etiology ; Coronary Circulation ; Coronary Vessels/physiopathology ; Diagnosis, Differential ; Dobutamine ; Echocardiography ; Female ; Gonadal Steroid Hormones/blood ; Hormone Replacement Therapy/adverse effects ; Humans ; Microcirculation/physiopathology ; Postmenopause/blood ; Prevalence ; Risk Factors
    Chemical Substances Cardiotonic Agents ; Gonadal Steroid Hormones ; Dobutamine (3S12J47372) ; Cholesterol (97C5T2UQ7J)
    Language English
    Publishing date 2001-05
    Publishing country United States
    Document type Comparative Study ; Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1067/mhj.2001.114198
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Ui IV Zs.15: Show issues Location:
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