Demilade Adedinsewo

Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003–2007

BACKGROUND The United States implemented mandatory folic acid fortification of enriched cereal grains in 1998. Although several studies have documented the resulting decrease in anemia and folate deficiency, to our knowledge, no one has determined the prevalence of folate-deficiency anemia after fortification. OBJECTIVE We determined the prevalence of folate deficiency and folate-deficiency anemia within a sample of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. DESIGN The REGARDS cohort is a prospective cohort of 30,239 black and white participants living in the contiguous United States. We measured serum folate concentrations in a random sample of 1546 REGARDS participants aged ≥50 y with baseline hemoglobin and red blood cell mean corpuscular volume measurements. Folate deficiency was defined as a serum folate concentration <6.6 nmol/L (<3.0 ng/mL), and anemia was defined as a hemoglobin concentration <13 g/dL in men and <12 g/dL in nonpregnant women (WHO criteria). Folate-deficiency anemia was defined as the presence of both folate deficiency and anemia. RESULTS The mean hemoglobin concentration was 13.6 g/dL, and 15.9% of subjects had anemia. The median serum folate concentration was 34.2 nmol/L (15.1 ng/mL), and only 2 of 1546 participants 0.1%) were folate deficient. Both subjects were African American women with markedly elevated C-reactive protein concentrations, macrocytosis, and normal serum cobalamin concentrations; only one subject was anemic. Overall, the prevalence of folate-deficiency anemia was <0.1% (1 of 1546 subjects). CONCLUSION Our data suggest that, after mandatory folic acid fortification, the prevalence of folate-deficiency anemia is nearly nonexistent in a community-dwelling population in the United States.

Prevalence and Factors Associated With Statin Use Among a Nationally Representative Sample of US Adults: National Health and Nutrition Examination Survey, 2011–2012

The 2013 American College of Cardiology/American Heart Association guidelines recommend statins for adults age ≤75 years who have clinical atherosclerotic cardiovascular disease (IA) and adults age 40 to 75 years with diabetes mellitus and LDL‐C 70–189 mg/dl (IA). Our aim was to estimate the prevalence and likelihood of statin use among selected statin benefit groups. Using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2012, we examined 5319 adults age ≥20 years. We estimated weighted frequencies and prevalence of statin use for adults with diabetes mellitus and dyslipidemia (or low‐density lipoprotein cholesterol ≥70 mg/dL), defined as statin benefit group 1 (SBG1); and for adults with atherosclerotic cardiovascular disease, defined as statin benefit group 2 (SBG2). We constructed a logistic regression model to estimate odds of statin use in SBG1. Overall, an estimated 38.6 million Americans are on a statin. In adjusted models, uninsured and Hispanic adults were less likely to be on a statin compared with white adults; 59.5% (95% confidence interval [CI]: 53.0‐66.1) of all adults in SBG1, 58.8% (95% CI: 51.5‐66.1) of adults age 40 to 75 in SBG1, and 63.5% (95% CI: 55.6‐71.4) of all adults in SBG2 were on a statin. Although the prevalence of statin use has increased over time, Hispanic ethnicity and lack of insurance remain barriers to statin use. Black‐white racial disparities were not significant. Our study provides a baseline estimate of statin use in the noninstitutionalized population just prior to introduction of the new guidelines and provides a reference for evaluating the impact of the new guidelines on statin utilization.

Comparison of Outcomes between Individuals with Pure and Mixed Lupus Nephritis: A Retrospective Study.

Introduction Lupus nephritis (LN) is a serious organ manifestation of systemic lupus erythematosus. Histologic overlap is relatively common in the six pathologic classes (I to VI) of LN. For example, mixed proliferative LN (MPLN) often includes features of classes III & V or classes IV & V combined. We performed a comparative evaluation of renal outcomes in patients with MPLN to patients with pure proliferative LN (PPLN) against pre-specified renal outcomes, and we also identified predictor of clinical outcomes among those with PPLN and MPLN. Hypothesis Individuals with MPLN will have worse short-term renal outcomes compared to those with PPLN. Methods We retrospectively reviewed 278 adult LN patients (≥18 years old) identified from an Emory University Hospital registry of native renal biopsies performed between January 2000 and December 2011. The final analytic sample consisted of individuals with a diagnosis of PPLN (n = 60) and MPLN (n = 96). We analyzed differences in clinical and laboratory characteristics at baseline. We also assessed associations between LN category and renal outcomes (complete remission and time to ESRD) with logistic and Cox proportional hazards models within two years of baseline. Results The study population was predominantly female (83.97%) and African American (71.8%) with a mean age of 33.4 years at baseline. Over a median follow up of 1.02 years, we did not find any statistically significant associations between MPLN and the development of ESRD or remission when compared to patients with PPLN (adjusted HR = 0.30, 95% CI = 0.07, 1.26). Conclusion There was no association between mixed or pure histopathologic features of LN at presentation and rate of complete or partial remission but higher baseline eGFR was associated with a lower probability of complete remission among patients with lupus nephritis.

Racial and Ethnic Disparities in Graft and Recipient Survival in Elderly Kidney Transplant Recipients

To investigate racial and ethnic differences in graft and recipient survival in elderly kidney transplant recipients.

Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation

Background— Recently published analysis of contemporary atrial fibrillation (AF) cohorts showed an association between digoxin and increased mortality and hospitalizations; however, other studies have demonstrated conflicting results. Many AF cohort studies did not or were unable to examine racial differences. Our goal was to examine risk factors for hospitalizations and mortality with digoxin use in a diverse real-world AF patient population and evaluate racial differences. Methods and Results— We performed a retrospective cohort analysis of claims data for Medicaid beneficiaries, aged 18 to 64 years, with incident diagnosis of AF in 2008 with follow-up until December 31, 2009. We created Kaplan–Meier curves and constructed multivariable Cox proportional hazard models for mortality and hospitalization. We identified 11 297 patients with an incident diagnosis of AF in 2008, of those, 1401 (12.4%) were on digoxin. Kaplan–Meier analysis demonstrated an increased risk of hospitalization with digoxin use overall and within race and heart failure groups. In adjusted models, digoxin was associated with an increased risk of hospitalization (adjusted hazard ratio, 1.54; 95% confidence interval, 1.39–1.70) and mortality (adjusted hazard ratio, 1.50; 95% confidence interval, 1.05–2.13). Overall, blacks had a higher risk of hospitalization but similar mortality when compared with whites regardless of digoxin use. We found no significant interaction between race and digoxin use for mortality (P=0.4437) and hospitalization (P=0.7122). Conclusions— Our study demonstrates an overall increased risk of hospitalizations and mortality with digoxin use but no racial/ethnic differences in outcomes were observed. Further studies including minority populations are needed to critically evaluate these associations.

Acute Rhabdomyolysis Following Synthetic Cannabinoid Ingestion

Context: Novel psychoactive substances, including synthetic cannabinoids, are becoming increasingly popular, with more patients being seen in the emergency room following acute ingestion. These substances have been associated with a wide range of adverse effects. However, identification of complications, clinical toxicity, and management remain challenging. Case Report: We present the case of a young African-American male who developed severe agitation and bizarre behavior following acute K2 ingestion. Laboratory studies revealed markedly elevated serum creatine phosphokinase (CPK) with normal renal function. The patient was managed with aggressive intravenous (IV) fluid hydration and treatment of underlying psychiatric illness. Conclusion: We recommend the routine evaluation of renal function and CPK levels with early initiation of IV hydration among patients who present to the emergency department following acute ingestion of synthetic cannabinoids to identify potential complications early as well as institute early supportive therapy.

Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use:

Background: β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use. Methods: We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure–related readmissions. Results: The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions. Conclusion: The BBT reduced 30-day, all-cause and heart failure–related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.

SLEEP APNEA RISK AND LETHAL VENTRICULAR ARRHYTHMIAS IN CONGESTIVE HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

Although implantable cardioverter defibrillator (ICD) insertion for primary prevention of sudden cardiac death from lethal ventricular arrhythmias (LVA) is expensive, up to 60% of heart failure patients with ICDs implanted according to current guidelines do not have LVA or device delivered therapy.

CARDIOVASCULAR DISEASE AMONG US ADULT MARIJUANA USERS: NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, 2011-2012

Marijuana is the most commonly abused drug in US. Studies have shown that cannabinoids up regulates pro-inflammatory cytokines and thrombogenesis which aids progression of atherosclerotic disease and lowers angina threshold. Our aim was to evaluate the association between marijuana and

Differentiating Left Ventricular Hypertrophy in Athletes from That in Patients With Hypertrophic Cardiomyopathy

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