Publications

BACKGROUND: Prediabetes is common among adults with hypertension, but its contribution to heart failure (HF) risk, particularly in the presence of subclinical myocardial abnormalities, remains uncertain.

OBJECTIVES: The objective of the study was to assess whether prediabetes combined with malignant left ventricular hypertrophy (LVH)-defined as LVH accompanied by subclinical myocardial injury or stress-is associated with increased HF risk in hypertensive adults without diabetes.

METHODS: This prospective cohort analysis included 8,131 hypertensive adults without diabetes or prior HF from the SPRINT (Systolic Blood Pressure Intervention Trial). LVH was defined using the Cornell voltage product. Subclinical myocardial injury was defined as high-sensitivity cardiac troponin I ≥6 ng/L (men) or ≥4 ng/L (women), and subclinical myocardial stress as N-terminal pro-B-type natriuretic peptide ≥125 pg/mL. Cox proportional hazards models estimated adjusted HRs and 95% CIs for HF.

RESULTS: During a median 3.3-year follow-up, 115 HF events occurred. Compared with normoglycemic adults without malignant LVH, those with both prediabetes and malignant LVH had higher HF risk (adjusted HR: 3.55; 95% CI: 1.98-6.36). Similar patterns were observed for prediabetes with LVH plus myocardial injury (HR: 4.02; 95% CI: 2.21-7.30) or stress (HR: 4.04; 95% CI: 2.22-7.34). Prediabetes alone was not associated with HF (adjusted HR: 1.24; 95% CI: 0.80-1.91).

CONCLUSIONS: Among hypertensive adults, the coexistence of prediabetes and malignant LVH identifies a subgroup at substantially elevated HF risk. Integrating glycemic status, ECG findings, and cardiac biomarkers may enhance HF risk stratification and inform preventive strategies.

BACKGROUND: Assessment and treatment of orthostatic hypotension (OH) are recommended to prevent falls in older adults. However, the optimal timing of standing blood pressure (BP) assessments to identify clinically relevant OH remains unclear.

METHODS: We measured 3 supine BP readings after 5 minutes of rest at 30-second intervals and 6 standing BP readings (timed at 0, 1, 2, 3, 4, and 5 minutes after standing) during the ARIC study (Atherosclerosis Risk in Communities) visit 10. OH was defined as a drop in BP (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) on standing from the supine position. We quantified the prevalence and predictors of initial OH (immediately after standing), early OH (within 3 minutes), late OH (after 3 minutes), and sustained OH (all 6 minutes). We examined their associations with orthostatic symptoms and falls using logistic regression and negative binomial models, respectively.

RESULTS: Of the 863 participants (mean age, 83.7 years), 41.3% had initial OH. Participants on antihypertensive medications had higher odds of all types of OH irrespective of controlled (<130/80 mm Hg) or uncontrolled (≥130/80 mm Hg) hypertension compared with those without hypertension (<130/80 mm Hg) and no antihypertensive use. Initial and early OH were strongly associated with orthostatic symptoms in the process of standing from the supine position (odds ratio, 2.34 [95% CI, 1.42-3.86]; odds ratio, 1.82 [95% CI, 1.11-2.98], respectively). Finally, participants with initial OH had higher fall rates (rate ratio, 1.45 [95% CI, 1.02-2.06]) than those without OH.

CONCLUSIONS: Measuring BP within 3 minutes of standing, particularly the first BP measurement immediately after standing, may provide clinicians with important information on falls risk and orthostatic symptoms.

The opioid crisis has remained a public health challenge in the US for more than two decades. After increasing from 2002 to 2012, opioid-related hospitalizations decreased from 2016 to 2019, but more recent trends are unknown. We sought to determine trends in incidence and outcomes of US opioid-related hospitalizations in recent years. We conducted a serial cross-sectional study of adult primary and secondary opioid-related hospitalizations, using the 2016-23 National Inpatient Survey and regression models, annual percent change, and z-tests to examine change during the study period. Measures included annual opioid-related hospitalizations, hospital stay outcomes, and sociodemographic characteristics. Among the 1.48 million opioid-related hospitalizations during 2016-23, survey-weighted to 7.42 million, 0.93 million were classified as primary and 6.49 million as secondary opioid-related hospitalizations. Hospitalizations decreased through 2023 for all groups except patients who were Hispanic or Native American, who reported Medicaid as their payer, or who were older than age sixty-five. The greatest decline occurred among people younger than age thirty-five. The proportion of hospitalizations ending in death and self-directed discharge increased by 0.58 percentage points and 2.68 percentage points, respectively. Overall, differential reductions in opioid-related hospitalizations and increasing mortality and self-directed discharge highlight opportunities for interventions.

INTRODUCTION: Previous research has shown narrowing racial disparities in self-reported health. However, these disparities may have worsened in recent years, particularly during and after the COVID-19 pandemic. Less is known regarding the current state of disparities in self-reported health.

METHODS: Participants are from the 2023 and 2024 U.S. National Health Interview Survey. Using survey-weighted, age- and sex-adjusted modified Poisson regression models, we examined associations of race, ethnicity, and socioeconomic status with fair or poor self-reported health, both overall and stratified by levels of education, income, and health insurance status.

RESULTS: Among 251,930,438 adults aged ≥ 18 years (unweighted N = 60,449), 14.9% (95% CI: 14.5, 15.3) reported fair or poor health. Compared to those with a bachelor's degree or higher, those who had not completed high school had a higher prevalence of fair or poor health (prevalence ratio [PR] = 3.79, 95% CI: 3.52, 4.08). Additionally, compared to people with household income ≥ 4 times the federal poverty line, those with household incomes below the federal poverty line had a higher prevalence of fair or poor health (PR = 3.94, 95% CI: 3.70, 4.19). Non-Hispanic Black (PR = 1.56, 95% CI: 1.46, 1.67) and Hispanic (PR = 1.49, 95% CI: 1.39, 1.59) adults were more likely than non-Hispanic White adults to report fair or poor health.

CONCLUSION: In this U.S. nationally representative study, fair or poor self-reported health was more prevalent among adults with lower socioeconomic status and among non-Hispanic Black and Hispanic adults. These findings underscore the need for policy interventions that simultaneously address socioeconomic inequality and structural racism to improve population health outcomes.

BACKGROUND: Exercise is important for people with multiple sclerosis (MS) to manage symptoms and improve quality of life. Tai chi and qigong (TCQ) are mind-body exercises shown to benefit physical, emotional, and cognitive health in many conditions, but research has been limited in people with MS. To understand potential benefits from regular TCQ practice and factors influencing feasibility, acceptability, and sustainability, we conducted a mixed-methods study through a survey and focus groups with people with MS who regularly practice TCQ.

METHODS: We conducted focus groups with people with MS from across the United States who regularly practice TCQ; the data from these groups were analyzed using reflexive thematic analysis. Participants also completed a brief survey that collected data on demographics, MS health history and symptoms, and TCQ practice (including opinions on content, dosage, and delivery).

RESULTS: Thirteen people with MS (85% female, 69% White) participated in the study. Reported TCQ benefits included physical (balance, strength), cognitive (memory), psychological (calming), and social (community building), with a dose-response gain over time. Challenges included learning and remembering movements, physical limitations (strength, endurance, fatigue), and transportation barriers. Adaptations specific to MS included tailoring TCQ content to meet individual needs and symptoms, appropriate pace, online delivery, and safety. Keys to sustainable practice included enjoyment, patience and self-compassion, viewing TCQ as medicine, and scheduling time for practice.

CONCLUSIONS: Results suggest people with MS who maintain a TCQ practice may experience physical, emotional, cognitive, and social benefits, especially when specific practice details and facilitators are met. Future studies might investigate how these factors influence sustainable practice.

BACKGROUND: Successful trial recruitment depends on balancing initial interest with participants' commitment and eligibility. It is uncertain how different motivational advertisement themes affect recruitment of interested and eligible trial participants.

METHODS: The GoFresh trials examined how healthy groceries affect blood pressure among Black adults from Boston healthy food priority areas. Using Facebook's "A/B testing" feature, users 18 years and older in eligible ZIP codes were randomly shown one of four digital advertisement themes-science volunteerism, study incentives, blood pressure reduction, or wellness in the Black community-between November 2023 and December 2024. We tracked Facebook and website analytics by theme. 'Interest' was defined as submission of an online interest form. 'Commitment' as visit no-show rates, and 'Eligibility' as qualification following the in-person visit. The 'number needed to screen' was calculated as 1 divided by the proportion of inquiries who were eligible.

RESULTS: Advertisements reached 603,418 Facebook users and generated 32,168 clicks, 264 inquiries, 73 scheduled visits, and 23 eligible participants. The community theme generated the highest inquiry engagement rate (54%) but lower commitment (8 no-shows) and the highest number needed to screen (17). The blood pressure theme had the lowest inquiry engagement rate (32%) but yielded the highest commitment (2 no-shows) and the lowest number needed to screen (8).

CONCLUSION: Beyond generating study interest, motivational themes may select for participants with varying degrees of commitment and eligibility, which could affect the cost-effectiveness of recruitment and long-term retention. These findings have important implications for timely and representative recruitment for cardiovascular trials.

REGISTRATION: URL: https://clinicaltrials.gov/; Unique Identifier: NCT05121337 &NCT05393232.

BACKGROUND: Clinical practice guidelines from the Endocrine Society recommend osteoporosis screening in high-risk men; however, the extent of implementation in clinical practice is unclear.

METHODS: We conducted a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS) from 2012 to 2019. We evaluated ordering patterns for dual-energy X-ray absorptiometry (DXA) during primary care visits among patients eligible for screening under the Endocrine Society Clinical Practice Guideline, based on guideline-concordant criteria operationalized using available NAMCS variables. We included men aged≥70 years and women aged≥65 years. Also, men aged 50-69 years and women aged 50-64 years with additional risk factors, such as body mass index<18.5 kg/m2, tobacco use, alcohol use disorder, or glucocorticoid therapy. We excluded visits among patients with osteoporosis. The trend in DXA screening was examined using multivariable, survey-weighted log-binomial regression models, and results are presented as relative risks (RR) with 95% confidence intervals (CI) and two-sided p-values.

RESULTS: We identified 4573 visits for eligible individuals. The median age was 72 years; 61% were women, 74% were non-Hispanic White, and 11% were non-Hispanic Black. The likelihood of DXA ordering was approximately 100 times less likely at visits among men suggested for screening (0.04%; 95% CI 0.00%-0.15%) than among women suggested for screening (5.1%; 95% CI 3.5%-7.1%). We observed no significant change in DXA ordering across survey years (p = 0.48). DXA ordering among women peaked at 6.9% in 2014-2016, while rates among men remained below 0.1%.

CONCLUSION: DXA ordering during U.S. primary care visits appears markedly low among men at risk for osteoporosis, representing a missed opportunity for early detection and fracture prevention.

Mindfulness-based interventions (MBIs) support health outcomes in people with cardiovascular disease (CVD) but have not been evaluated among people with HIV (PWH) at risk for CVD. This qualitative study assessed perceived feasibility and acceptability of mindfulness among PWH to inform its inclusion in a CVD risk reduction intervention. Four focus group discussions (N = 23) were conducted; facilitator shared mindfulness (breath and body scan) practices and solicited feedback. On average, the sample was 61-years-old (SD = 6.6), cisgender men (57%), Caucasian (52%) with an annual income ⩽$20,000 (60%). From the content analysis, participants indicated they could engage in these or similar mindfulness practices. Potential barriers included trouble sustaining attention, and low motivation for self-led practice. Both positive (relaxation) and negative (focus on pain) practice effects were reported. Participants identified mindfulness could help manage psychological distress and engage in positive health behaviors. Mindfulness practices warrant inclusion and evaluation in CVD risk reduction interventions for PWH.

BACKGROUND: Preoperative blood Tau phosphorylated at threonine 217 (Tau-PT217), a newly identified blood biomarker of Alzheimer's disease, is associated with postoperative delirium in patients. Anesthesia/surgery is also associated with postoperative increased blood Tau-PT217 amounts in patients. Moreover, in female aged mice, anesthesia/surgery increases Tau-PT217 in lungs, blood and brain tissues, leading to behavioral changes. However, whether these effects are sex-dependent remain largely undetermined.

METHODS: Eighteen-month-old female and male mice (C57BL/6J) underwent abdominal surgery under general anesthesia (1.4% isoflurane and 40% oxygen). Levels of Tau-PT217, inflammatory markers, and GSK3β activity were measured in lungs, blood, and brain tissues of aged mice using nanoneedle technology, Western blot, immunohistochemistry, RT-PCR and others. Postoperative delirium-like behavior was assessed using a battery of behavioral tests (buried food, open filed and Y maze). To explore causality, we performed orchiectomy and administered androgen receptor antagonist enzalutamide in aged male mice. Finally, testosterone was delivered via inhalation to aged female mice.

RESULTS: Anesthesia/surgery increased the amounts of Tau-PT217 in lungs (2.29±0.16 fold versus 1.15±0.71 fold, P<0.01), blood, and brain tissues of aged female, but not male, mice compared to control condition, leading to postoperative delirium-like behavior, as evidenced by increases in the composite Z score (3.74±1.46 versus 0.60±1.17, P<0.01), in the aged female, but not male, mice. Anesthesia/surgery elevated inflammatory markers and GSK3β activity in aged female mice, which exhibited lower baseline testosterone levels and androgen receptor expression in lungs compared to males. Both orchiectomy and enzalutamide treatment in male mice reduced testosterone levels and androgen receptor expression, leading to elevation of Tau-PT217 amounts and behavior changes following anesthesia/surgery. Conversely, testosterone inhalation in aged female mice mitigated the anesthesia/surgery-induced elevation of Tau-PT217 amounts and behavior changes.

CONCLUSIONS: Testosterone and androgen receptor signaling may contribute to the sex-dependent differences in Tau phosphorylation and postoperative behavior changes in aged mice.