Iqbal Krishan

Black-white differences in serum lipids and lipoproteins in Evans County

Abstract The Evans County Cardiovascular Disease Survey has demonstrated a higher prevalence and incidence of coronary heart disease in white than in black men. Prior studies by us have disclosed similar associations of CHD with the risk factors of elevated blood pressure, serum cholesterol, and smoking in Evans County as have been reported elsewhere. The lower frequencies of CHD in black than in white males are present, controlling for the standard risk factors in univariate and in multivariate logistic risk function analyses. Black-white differences in total serum triglyceride and in cholesterol within lipoprotein fractions at identical total serum cholesterol levels are described in this report. Significantly higher LDL cholesterol and total triglycerides are present in whites, and higher HDL cholesterol was found in blacks in an age, sex, and total serum cholesterol matched comparison. The determinants of the black-white differences in lipid and lipoprotein fraction distributions are still to be elucidated, but in this sample, lipid differences are not explained by social characteristics, such as occupation and social class. The black-white lipoprotein fraction differences in Evans County are consistent with a negative, coronary risk factor role of elevated HDL cholesterol, which has been postulated based on other experimental and prevalence studies.

Is Percutaneous Coronary Angioplasty Less Expensive Than Bypass Surgery

Percutaneous transluminal coronary angioplasty is widely considered to be an acceptable and less expensive alternative to bypass surgery in carefully selected patients. We compared expenditures related to cardiac care for 79 unselected patients undergoing coronary angioplasty with expenditures for 89 unselected patients undergoing elective coronary bypass surgery without a previous attempt at angioplasty. All the patients had single-vessel disease. The mean aggregate one-year monetary outlay was 15 per cent lower in the angioplasty group than in the bypass-surgery group. A major component of the expense of angioplasty was the treatment of restenosis in the 33 per cent of patients in this group in whom this late complication occurred. We conclude that percutaneous transluminal coronary angioplasty has potential for reducing expenditures for cardiac revascularization and that a further reduction may be obtainable when the rates of restenosis are improved.

Assessment of Prediction of Mortality by Using the APACHE II Scoring System in Intensive-Care Units

Some investigators have suggested that information on quality of care in intensive-care units (ICUs) may be inferred from mortality rates. Specifically, the ratio of actual to predicted hospital mortality (A/P) has been proposed as a valid measure for comparing ICU outcomes when predicted mortality has been derived from data collected during the first 24 hours of ICU therapy with use of a severity scoring tool, APACHE II (acute physiology and chronic health evaluation). We present a comparison of mortality ratios (A/P) in four ICUs under common management, in two hospitals within a single institution. Significant differences in A/P were detected for nonoperative patients (0.99 versus 0.67;P = 0.014) between the two hospitals. This variation was traced to uneven representation of a subset of patients who had chronic health problems related to diseases that necessitated admission to the hematology-oncology or hepatology service. No differences in A/P were seen between the two hospitals for operative patients or for nonoperative patients on services other than hematology-oncology or hepatology. Thus, differences in A/P detected by using the APACHE II system not only may reside in operational factors within the ICU organization but also may be related to weaknesses in the APACHE II model to measure factors intrinsic to the disease process in some patients. We suggest that case-mix must be examined in detail before concluding that differences in A/P are caused by differences in quality of care.

Contribution of a measure of disease complexity (COMPLEX) to prediction of outcome and charges among hospitalized patients.

Attention has been focused on the need to adjust hospital reimbursement and outcomes of hospital care for level of illness. Extant measures of disease severity, however, fail to consider the contribution of disease complexity. We developed an easily retrievable measure of disease complexity (COMPLEX) by modifying an existing severity system, computerized Disease Staging. The contribution of COMPLEX (the number of body systems affected with a Disease Staging score of 2 or more) to the prediction of outcome was assessed in two studies: (1) a population-based analysis of readmission and mortality after hospitalization and (2) an analysis of hospital charges among patients who were in an intensive-care unit. The amount of variation in mortality explained by factors included in the Health Care Financing Administration model was significantly improved when COMPLEX was added to the model (adjusted odds ratio per body system, 1.83; 95% confidence interval, 1.61 to 2.08). A significant association was also observed between COMPLEX score and hospital readmission after adjustment for age, sex, case-mix, and disease severity (adjusted odds ratio, 1.31; 95% confidence interval, 1.20 to 1.44). When COMPLEX was added to case-mix and disease severity in a model for predicting hospital charges, the percentage of variation in hospital charges explained by the model increased from 25% to 38%. These findings demonstrate the important contribution of disease complexity to the analysis of outcome of medical care and utilization of resources. Outcome or reimbursement models that do not incorporate disease complexity may negatively affect institutions with a high proportion of patients who have complex conditions.

Trends in Elderly Hospitalization and Readmission Rates for a Geographically Defined Population: Pre- and Post-Prospective Payment

To address the paucity of patient‐level data regarding the effectiveness of Medicares prospective payment system (PPS), we conducted a population‐based study of inpatient hospitalizations among individually identified elderly residents of Olmsted County, Minnesota, 1970–1987.

Genetic lipoprotein variation and lipid levels in man.

Analyses of 12 population samples have revealed that the total serum cholesterol level is significantly higher in Lp(a+) than in Lp(a–) individuals. The difference is more pronounced in middle‐aged and older people than in young persons, and the difference between Lp(a‐h) and Lp(a–) individuals is larger when LDL cholesterol rather than total serum cholesterol is considered. Lp(a –) individuals have a significantly higher triglyceride level than Lp(a +) individuals.

Prospective Study of Cord Blood Cholesterol to Predict Level of Cholesterol and Type II Hyperlipoproteinemia in Adolescence

Between January 1958 and July 1960, maternal and cord blood was obtained from 571 consecutive live births in a biracial rural general practice in Georgia, USA. Following delivery of the infant, blood was obtained from a clean cut of the umbilical cord. Maternal blood was obtained at the same time.