American Journal of Medicine最新文献

{"title":"Lipid Profiling in Obesity: The Limitations of the Friedewald Equation.","authors":"Haoyi Zheng","doi":"10.1016/j.amjmed.2024.09.011","DOIUrl":"10.1016/j.amjmed.2024.09.011","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking cessation and the odds of developing hypertension in a working-age male population; the impact of body weight changes.","authors":"Yoshiyuki Saiki, Toshiaki Otsuka, Yasuhiro Nishiyama, Katsuhito Kato, Kuniya Asai, Tomoyuki Kawada","doi":"10.1016/j.amjmed.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>Smoking elevates blood pressure (BP) whereas smoking cessation increases body weight (BW), which predisposes new quitters to the development of hypertension. This study aimed to investigate the effect of smoking cessation and subsequent BW change on the odds of developing hypertension.</p><p><strong>Methods: </strong>A total of 10,354 Japanese male workers without hypertension who underwent a baseline annual medical checkup were followed up for three years to detect the development of hypertension. They were divided into six groups according to their smoking status (non-smokers, new quitters, or continuous smokers) and BW change (≥3 kg or <3 kg) during the follow-up period. Logistic regression analysis was used to calculate odds ratio (OR) for developing hypertension.</p><p><strong>Results: </strong>During the follow-up period, 1,032 participants (mean age, 38.4 ± 8.8 years) developed hypertension. After adjusting for multiple potential confounders, the odds of developing hypertension were significantly higher in new quitters with BW gains ≥3 kg (OR, 2.95, 95% confidence interval [CI], 1.37-6.35) compared to non-smokers with BW gains <3 kg. However, increased odds of developing hypertension were not observed in those with BW gains <3 kg (OR, 0.90, 95% CI, 0.52-1.58). Continuous smokers were at increased odds of developing hypertension regardless of their BW changes (BW gain <3 kg, OR, 1.35, 95% CI, 1.13-1.61 vs BW gain ≥3 kg, OR, 1.90, 95% CI, 1.43-2.52).</p><p><strong>Conclusions: </strong>The odds of developing hypertension were increased in new quitters only when their BW gain was not controlled after smoking cessation.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure Mortality in Chronic Kidney Disease: The Fatal Crossover.","authors":"Yong-Hao Yeo, Boon-Jian San, Xuan-Ci Mee, Min Choon Tan, Amr E Abbas, Madhan Shanmugasundaram, Justin Z Lee, Aiden Abidov, Kwan S Lee","doi":"10.1016/j.amjmed.2024.09.002","DOIUrl":"10.1016/j.amjmed.2024.09.002","url":null,"abstract":"<p><strong>Background: </strong>Real-world mortality data regarding heart failure in patients with comorbid chronic kidney disease remains limited, especially following the advent of advanced heart failure therapies.</p><p><strong>Methods: </strong>Using the CDC WONDER database, we included patients ≥ 25 years old who died primarily from heart failure (2011-2020) with comorbid chronic kidney disease. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals. We determined the trends over time by estimating the annual percent change (APC) using the Joinpoint regression program.</p><p><strong>Results: </strong>There were 82,454 heart failure deaths with comorbid chronic kidney disease. The AAMR increased from 2.34 (95% CI, 2.28-2.41) in 2011 to 4.79 (95% CI, 4.71-4.88) in 2020. During the study period, Heart failure deaths among patients with comorbid chronic kidney disease increased by 149.0% compared to 59.9% in those without. Men had higher AAMR than women (3.92 [95% CI, 3.88-3.96] vs. 2.96 [95% CI, 2.93-2.99]). African American patients had the highest AAMR (5.85 [95% CI, 5.75-5.96]). The Midwest region had the highest AAMR (3.83 [95% CI, 3.78-3.89]). The AAMR was higher in the rural areas than in the urban regions (3.77 [95% CI, 3.71-3.83] vs. 3.23 [95% CI, 3.20-3.25]). Most patients died in hospices or nursing homes (29,000, 35.2%).</p><p><strong>Conclusion: </strong>Our study showed a significant increase in heart failure AAMR in patients with comorbid chronic kidney disease in recent eras. Further effort is needed to optimize cardioprotective agents for this population and to address demographic discrepancies at the policy level.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Electrocardiogram Findings With Clinical Outcomes in Patients With Chronic Coronary Syndrome: An Analysis of the ISCHEMIA Trials.","authors":"Anselm Jorda, Theresa Pecho, Lisa Christina Horvath, Ersilio Nishani, Leslie E Bull, Felix Bergmann, Christian Nitsche, Markus Zeitlinger, Bernd Jilma, Georg Gelbenegger","doi":"10.1016/j.amjmed.2024.09.007","DOIUrl":"10.1016/j.amjmed.2024.09.007","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the association of electrocardiogram (ECG) findings with outcomes in patients with chronic coronary syndrome.</p><p><strong>Methods: </strong>This secondary analysis of the ISCHEMIA and ISCHEMIA-CKD trials divided patients with chronic coronary syndrome into two groups, those with a normal ECG tracing and abnormal ECG tracing. Repolarization abnormalities included ST-segment depression ≥ 0.5 mm and T-wave inversion ≥ 1 mm; conduction abnormalities included left and right bundle branch block (LBBB and RBBB). The primary endpoint was cardiovascular death. Outcomes were assessed using a covariate-adjusted Cox-regression model.</p><p><strong>Results: </strong>Of 5876 patients, 2901 (49.4%) had a normal and 2975 (50.6%) an abnormal ECG tracing. An abnormal ECG tracing at baseline, compared with a normal ECG tracing, was associated with an increased risk of cardiovascular death (257 of 2975 [8.6%] vs. 97 of 2901 [3.3%], adjusted hazard ratio [aHR] 2.01, 95% CI 1.58-2.55) over a median follow-up period of 3.1 years (IQR 2.1-4.2). This finding was consistent across subgroups except for patients with black skin color and current smokers, in whom an abnormal ECG was not significantly associated with increased risk of cardiovascular death. Individual ECG abnormalities (ST-segment depression [aHR 2.0, 95% CI 1.52-2.63], T-wave inversion [aHR 1.89, 95% CI 1.40-2.54], LBBB [aHR 1.74, 95% CI 1.05-2.90], and RBBB [aHR 1.52, 95% CI 1.04-2.22]) were independently associated with an increased risk of cardiovascular death.</p><p><strong>Conclusion: </strong>In patients with chronic coronary syndrome, an abnormal ECG tracing was associated with an increased risk of cardiovascular death. Our findings underscore the importance of the ECG in cardiovascular risk stratification and prognostication.</p><p><strong>Trial registration: </strong>NCT01471522, BioLINCC ID 14539.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case-Based Approach to the Management of Patients with Chronic Coronary Disease: Updates from the 2023 AHA/ACC Guidelines.","authors":"Yoo Jin Kim, Jasmine Malhi, Jeff Trost, Thorsten Leucker, Salim S Virani, L Kristin Newby, Roger S Blumenthal, Essa Hariri","doi":"10.1016/j.amjmed.2024.09.013","DOIUrl":"10.1016/j.amjmed.2024.09.013","url":null,"abstract":"<p><p>The 2023 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline for the Management of Patients with Chronic Coronary Disease presents important updates to the care of patients with chronic coronary disease. The recommendations of these guidelines inform the care for patients with 1) asymptomatic coronary artery disease, 2) stable angina or equivalent symptoms (e.g., dyspnea upon exertion), 3) symptomatic nonobstructive coronary disease including coronary microvascular dysfunction and vasospasm, and 4) left ventricular (LV) systolic dysfunction with known coronary artery disease. In this review, we aim to demonstrate key recommendations in the 2023 guideline using the following four hypothetical cases.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burton's Line.","authors":"Kaoru Hama, Kosuke Ishizuka, Naohito Kuronuma, Koichiro Yoshie, Mitsuyasu Ohta","doi":"10.1016/j.amjmed.2024.09.014","DOIUrl":"10.1016/j.amjmed.2024.09.014","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Consensus on the Diagnosis and Management of Digoxin Toxicity.","authors":"Jason B Hack, Sue Wingate, Ron Zolty, Michael W Rich, Paul J Hauptman","doi":"10.1016/j.amjmed.2024.08.018","DOIUrl":"10.1016/j.amjmed.2024.08.018","url":null,"abstract":"<p><p>While there has been a decline in the use of digoxin in patients with heart failure and atrial fibrillation, acute and chronic digoxin toxicity remains a significant clinical problem. Digoxin's narrow therapeutic window and nonspecific signs and symptoms of toxicity create clinical challenges and uncertainty around the diagnostic criteria of toxicity and responsive treatment choices for the bedside clinician. A systematic review of published literature on digoxin toxicity (34,587 publications over 6 decades, with 114 meeting inclusion criteria) was performed to develop 33 consensus statements on diagnostic and therapeutic approaches which were then evaluated through a modified Delphi process involving a panel of experts in cardiology, nursing, emergency medicine, and medical toxicology. The results demonstrate agreement about the need to consider time of ingestion and nature of the exposure (ie, acute, acute-on-chronic, chronic) and the use of digoxin immune Fab for life-threatening exposure to decrease risk of death. While several areas of continued uncertainty were identified, this work offers formalized guidance that may help providers better manage this persistent clinical challenge.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Recognition, and Follow-up of Laboratory Evidence of Acute Kidney Injury in Primary Care Practices: Analysis of 93,259 Creatinine Results.","authors":"Jose Mena, Marc Rodriguez, Scot B Sternberg, Timothy Graham, Leonor Fernandez, James Benneyan, Talya Salant, Amie Pollack, Dru Ricci, Russell S Phillips, Umber Shafiq, Mark D Aronson, Gordon D Schiff, Bradley M Denker","doi":"10.1016/j.amjmed.2024.08.032","DOIUrl":"10.1016/j.amjmed.2024.08.032","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired acute kidney injury (CA-acute kidney injury) is under-recognized in the outpatient setting and is associated with adverse outcomes.</p><p><strong>Methods: </strong>We analyzed the incidence of CA-acute kidney injury in an academic primary care practice and community health center and assessed recognition and follow-up as determined by repeat creatinine measurement (closed-loop). We reviewed 93,259 specimens for 36,593 unique patients from January 1, 2018, through December 31, 2021.</p><p><strong>Results: </strong>There were 220 unique patients with CA-acute kidney injury, defined as a > 75% increase in creatinine from baseline (incidence: 150/100,000; 0.15% per year). One hundred thirty seven patients (62.3%) had repeat serum creatinine performed within 30 days. Chart reviews of the 83 (37.72%) patients with open loops found there was no follow-up creatinine ordered in 69/83 (83.1%) patients. Mean baseline creatinine was higher and estimated glomerular filtration rate (eGFR) was lower in the closed-loop group (0.92 ± 0.4 mg/dL; 84.45 ± 27.49 mL/min) vs the open-loop group (0.63 ± 0.34 mg/dL; 105.19 ± 26.67 mL/min) (P < .0001). Preexisting chronic kidney disease was more prevalent in closed-loop patients (35/137; 25.6%) compared with those with open loops (3/83; 3.6%). Patients with baseline chronic kidney disease were more likely to have closed loops. Progression to new chronic kidney disease was common among CA-acute kidney injury patients, occurring in 25% of open-loop and 24.1% of closed-loop patients. New baseline eGFR was lower in all groups.</p><p><strong>Conclusions: </strong>Clinicians frequently overlooked a clinically significant change in eGFR, especially when the baseline creatinine and incident creatinine levels were in the \"normal\" range.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Patient and System Delays and In-Hospital Mortality in Primary PCI for STEMI: Findings from a Large, Nationwide Inpatients Sample.","authors":"Hongbo Yang, Lingfeng Luo, Zheyong Huang, Yanan Song, Jiatian Cao, Xueyi Weng, Feng Zhang, Xiaofeng Zhou, Juying Qian, Junbo Ge, Yan Zheng","doi":"10.1016/j.amjmed.2024.08.024","DOIUrl":"10.1016/j.amjmed.2024.08.024","url":null,"abstract":"<p><strong>Purpose: </strong>System delay is associated with mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). However, the influence of patient delay has been relatively overlooked. We aimed to evaluate the influence of patient and system delays on STEMI patients undergoing primary PCI in China.</p><p><strong>Methods: </strong>STEMI patients registered at the Nationwide Chinese Cardiovascular Association Database-Chest Pain Center from January 2017 to September 2021 were screened. The exposures were total ischemic time (TIT), system delay and patient delay. The primary outcome was in-hospital mortality.</p><p><strong>Results: </strong>Among 458,260 patients from 2529 centers, median TIT, system delay and patient delay were 4.1, 1.5 and 2.1 hours, respectively. The adjusted odds ratio of in-hospital mortality increased by 2.2% (odds ratio [OR], 1.022, 95% confidence interval [CI], 1.017-1.027), 2.3% (1.023, 1.006-1.040) and 2.2% (1.022, 1.017-1.027) for every one-hour increase in TIT, system delay and patient delay, respectively.</p><p><strong>Conclusions: </strong>Patient delay demonstrated a comparable impact to system delay on in-hospital mortality among STEMI patients undergoing primary PCI. Widespread primary PCI-capable center, improved awareness about myocardial infarction and regional transfer system are essential to shorten patient delay.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Composition, Vascular Health, Cardiorespiratory Fitness, Lung Function, Muscle Architecture, and Physical Activity in People with Young Onset Dementia: A Case-Control Study.","authors":"Lawrence D Hayes, Ethan C J Berry, Nilihan E M Sanal-Hayes, Nicholas F Sculthorpe, Duncan S Buchan, Marie Mclaughlin, Sowmya Munishankar, Debbie Tolson","doi":"10.1016/j.amjmed.2024.08.027","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.08.027","url":null,"abstract":"<p><strong>Background: </strong>Body composition, blood pressure, estimated maximal oxygen uptake (VO_2max), lung function, physical activity, muscle architecture, and endothelial function had not previously been examined in people with young onset dementia. Therefore, the study measured these variables in a young onset dementia group, compared them to age-matched controls.</p><p><strong>Methods: </strong>Estimated VO_2max (via the Astrand-Rhyming test), body composition, blood pressure, lung function (via spirometry), muscle architecture (via ultrasonography) and endothelial function (via flow mediated dilation) were assessed. Physical activity was measured using ActiGraph accelerometers for 7 days.</p><p><strong>Results: </strong>We recruited 33 participants (16 young onset dementia, 17 controls). The young onset dementia group had shorter fascicle lengths of the vastus lateralis, were sedentary for longer over a seven-day period, and completed less moderate-vigorous physical activity than controls (p=0.028, d=0.81; large effect, p=0.029, d=0.54; moderate effect, and p=0.014, d=0.97; large effect, respectively for pairwise comparisons). Pairwise comparisons suggest no differences at the p<0.05 level between young onset dementia and controls for estimated VO_2max (despite a moderate effect size [d=0.66]), height, body mass, BMI, blood pressure, light physical activity, lung function, muscle thickness, pennation angle, or endothelial function.</p><p><strong>Conclusion: </strong>This study highlights differences between people with young onset dementia and controls, underscoring the need for multicomponent exercise interventions. Future interventions should target muscle architecture, increase moderate-vigorous physical activity, and reduce sedentariness, with the goal of improving quality of life and promoting functional independence.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}