Hypertension in Women of Reproductive Age in the United States: NHANES 1999-2008

Objective: To examine the epidemiology of hypertension in women of reproductive age. Methods: Using NHANES from 1999–2008, we identified 5,521 women age 20–44 years old. Hypertension status was determined using blood pressure measurements and/or self-reported medication use. Results: The estimated prevalence of hypertension in women of reproductive age was 7.7% (95% confidence interval (CI): 6.9%–8.5%). The prevalence of anti-hypertensive pharmacologic therapy was 4.2% (95% CI 3.5%–4.9%). The prevalence of hypertension was relatively stable across the study period; the age and race adjusted odds of hypertension in 2007–2008 did not differ significantly from 1999–2000 (odds ratio 1.2, CI 0.8 to 1.7, p = 0.45). Significant independent risk factors associated with hypertension included older age, non-Hispanic black race (compared to non-Hispanic whites), diabetes mellitus, chronic kidney disease, and higher body mass index. The most commonly used antihypertensive medications included diuretics, angiotensin-converting enzyme inhibitors (ACE), and beta blockers. Conclusion: Hypertension occurs in about 8% of women of reproductive age. There are remarkable differences in the prevalence of hypertension between racial/ethnic groups. Obesity is a risk factor of particular importance in this population because it affects over 30% of young women in the U.S., is associated with more than 4 fold increased risk of hypertension, and is potentially modifiable

Амилоид-бета 40 как биомаркер когнитивных нарушений в остром периоде ишемического инсульта

Aim: to study the role of amyloid-beta 40 (Aβ 40) in the development of cognitive impairment in acute ischemic stroke.Materials and methods. The study included 70 patients aged 33–86 years, 46 men and 24 women. In patients with acute ischemic stroke cognitive status was assessed with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Test (MoCA), Frontal Assessment Battery (FAB), Schulte tables, Clock Drawing Test, Test for Semantic Verbal Fluency and Five Words Test. The concentration of Aβ 40 in the cerebrospinal fluid was determined. Morphometric (size of the infarct and leukoaraiosis area, volume of the brain ventricles and hippocampus) and diffusion-tensor parameters of MRI (fractional anisotropy of putamen, thalamus, hippocampus, corpus callosum, limbs of the internal capsule, the cingulate, the superior longitudinal and inferior fronto-occipital tracts) were studied.Results. The concentration of Aβ 40 in the cerebrospinal fluid was 436,4 (226,0–514,0) pg/ml. The protein level was associated with the result of subtests «Orientation» (MMSE) and «Attention» (MoCA), as well as indirect recall with cues in MoCA. Patients with MMSE score of 24–27 points were characterized by a lower concentration of Aβ 40 as compared to patients with a score less than 24 points. Aβ 40 concentration more than 436,4 pg/mL was associated with a more severe somatic co-morbidity of stroke (hypertension, lower hemoglobin and albumin level, higher erythrocyte sedimentation rate), a smaller volume of the brain ventricles, lower fractional anisotropy of the thalamus, cingulate tracts and contralateral hippocampus. Aβ 40 concentration more than 436,4 pg/mL was also associated with a lower global cognitive status (according to the MMSE and MoCA), as well as the reduction in certain cognitive functions, namely, attention, visual-spatial functions and memory.Conclusions. The concentration of Aβ 40 in the cerebrospinal fluid is a biological marker of severity type of post-stroke cognitive impairment. This interaction is probably due to the damage to the hippocampus, thalamus and cingulate tracts. In our opinion, the biomarker reflects both ischemic and neurodegenerative components of the pathogenesis of cognitive impairment in acute ischemic stroke.Цель исследования. Изучение роли амилоида-бета 40 (Aβ 40) в развитии когнитивных нарушений в остром периоде ишемического инсульта.Материал и методы. Обследованы 70 пациентов в возрасте 33–86 лет, из которых 46 мужчин и 24 женщины.У пациентов в остром периоде ишемического инсульта проводилась оценка когнитивного статуса (краткая шкала оценки психического статуса (MMSE), Монреальская шкала оценки когнитивных функций (MoCA), батарея лобных тестов (FAB), таблицы Шульте, тест рисования часов, тест на семантическую вербальную беглость и тест пяти слов). Также исследовалась концентрации Аβ 40 в ликворе, изучались морфометрические (размер очага инфаркта и площадь лейкоареоза, объем желудочков мозга и гиппокампов) и диффузионно-тензорные показатели (фракционная анизотропия скорлупы, таламуса, гиппокампа, мозолистого тела, ножек внутренней капсулы, цингулярного, верхнего продольного и нижнего фронто-окципитального пучков) магнитно-резонансной томографии.Результаты. Концентрация Аβ 40 в ликворе составила 436,4 (226,0–514,0) пг/мл и была ассоциирована с результатом субтестов «ориентация» (MMSE) и «внимание» (MoCA), а также опосредованным воспроизведением в MoCA. Пациенты с результатом MMSE 24–27 баллов характеризовались более низкой концентрацией Аβ 40 по сравнению с пациентами с результатом шкалы менее 24 баллов. Концентрация Аβ 40 более 436,4 пг/мл была связана с более выраженной соматической коморбидностью инсульта (артериальная гипертензия, более низкое содержание гемоглобина и альбумина крови, более высокая скорость оседания эритороцитов), меньшим объемом желудочков мозга, более низкой фракционной анизотропией таламусов, цингулярных пучков и контралатерального гиппокапма и ассоциирована с более низким глобальным когнитивным статусом (по результатам MMSE и MoCA), а также снижением отдельных когнитивных функций, а именно внимания, зрительно-пространственного гнозиса и памяти.Выводы. Концентрация Аβ 40 в спинномозговой жидкости является биологическим маркером как выраженности, так и характера постинсультных когнитивных нарушений, что, вероятно, опосредовано повреждением гиппокампов, таламуса и цингулярных трактов. При этом, на наш взгляд, биомаркер отражает как сосудистый, или ишемический, компонент патогенеза когнитивных нарушений в остром периоде ишемического инсульта, так и влияние амилоид-опосредованной нейродегенерации

Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals

Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database.Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications.After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999-2000 to 14.46 in 2007-2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18-59 year old group was found to be 24% (p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered.Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure

Sodium and potassium intakes among US adults: NHANES 2003–2008

Background: The American Heart Association (AHA), Institute of Medicine (IOM), and US Departments of Health and Human Services and Agriculture (USDA) Dietary Guidelines for Americans all recommend that Americans limit sodium intake and choose foods that contain potassium to decrease the risk of hypertension and other adverse health outcomes. Objective: We estimated the distributions of usual daily sodium and potassium intakes by sociodemographic and health characteristics relative to current recommendations. Design: We used 24-h dietary recalls and other data from 12,581 adults aged $20 y who participated in NHANES in 2003–2008. Estimates of sodium and potassium intakes were adjusted for withinindividual day-to-day variation by using measurement error models. SEs and 95$51 y or persons with hypertension, diabetes, or chronic kidney disease), 98.8% (98.4%, 99.2%) overall consumed .1500 mg/d, and 60.4% consumed .3000 mg/d—more than double the recommendation. Overall, ,2% of US adults and w5% of US men consumed $4700 mg K/d (ie, met recommendations for potassium). Conclusion: Regardless of recommendations or sociodemographic or health characteristics, the vast majority of US adults consume too much sodium and too little potassium

Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults, United States, 1999–2006

PURPOSE Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults

Amyloid-beta 40 as a biomarker of cognitive impairment in acute ischemic stroke

Aim: to study the role of amyloid-beta 40 (Aβ 40) in the development of cognitive impairment in acute ischemic stroke.Materials and methods. The study included 70 patients aged 33–86 years, 46 men and 24 women. In patients with acute ischemic stroke cognitive status was assessed with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Test (MoCA), Frontal Assessment Battery (FAB), Schulte tables, Clock Drawing Test, Test for Semantic Verbal Fluency and Five Words Test. The concentration of Aβ 40 in the cerebrospinal fluid was determined. Morphometric (size of the infarct and leukoaraiosis area, volume of the brain ventricles and hippocampus) and diffusion-tensor parameters of MRI (fractional anisotropy of putamen, thalamus, hippocampus, corpus callosum, limbs of the internal capsule, the cingulate, the superior longitudinal and inferior fronto-occipital tracts) were studied.Results. The concentration of Aβ 40 in the cerebrospinal fluid was 436,4 (226,0–514,0) pg/ml. The protein level was associated with the result of subtests «Orientation» (MMSE) and «Attention» (MoCA), as well as indirect recall with cues in MoCA. Patients with MMSE score of 24–27 points were characterized by a lower concentration of Aβ 40 as compared to patients with a score less than 24 points. Aβ 40 concentration more than 436,4 pg/mL was associated with a more severe somatic co-morbidity of stroke (hypertension, lower hemoglobin and albumin level, higher erythrocyte sedimentation rate), a smaller volume of the brain ventricles, lower fractional anisotropy of the thalamus, cingulate tracts and contralateral hippocampus. Aβ 40 concentration more than 436,4 pg/mL was also associated with a lower global cognitive status (according to the MMSE and MoCA), as well as the reduction in certain cognitive functions, namely, attention, visual-spatial functions and memory.Conclusions. The concentration of Aβ 40 in the cerebrospinal fluid is a biological marker of severity type of post-stroke cognitive impairment. This interaction is probably due to the damage to the hippocampus, thalamus and cingulate tracts. In our opinion, the biomarker reflects both ischemic and neurodegenerative components of the pathogenesis of cognitive impairment in acute ischemic stroke