Relation between C reactive protein and depression remission status in patients presenting with acute coronary syndrome

Although depression symptoms are associated with an increased risk of recurrent cardiovascular disease in patients who have experienced an acute coronary syndrome (ACS) event, the exact mechanisms remain poorly understood. Inflammation has been suggested to be a mechanism in the depression–ACS prognosis link, as raised concentrations of inflammatory biomarkers, especially C reactive protein (CRP), are associated with recurrent cardiovascular events.1 In the few studies that have examined the relation between depression status and CRP concentrations after an ACS event, depression and CRP concentrations were assessed 2–6 months after the index ACS event, when the rate of depression remission would already be relatively high.2–4 The objective of this study was to examine the relation between the course of depression and CRP concentrations after an ACS event

Estimating forest structure in a tropical forest using field measurements, a synthetic model and discrete return lidar data

Tropical forests are huge reservoirs of terrestrial carbon and are experiencing rapid degradation and deforestation. Understanding forest structure proves vital in accurately estimating both forest biomass and also the natural disturbances and remote sensing is an essential method for quantification of forest properties and structure in the tropics. Our objective is to examine canopy vegetation profiles formulated from discrete return LIght Detection And Ranging (lidar) data and examine their usefulness in estimating forest structural parameters measured during a field campaign. We developed a modeling procedure that utilized hypothetical stand characteristics to examine lidar profiles. In essence, this is a simple method to further enhance shape characteristics from the lidar profile. In this paper we report the results comparing field data collected at La Selva, Costa Rica (10° 26′ N, 83° 59′ W) and forest structure and parameters calculated from vegetation height profiles and forest structural modeling. We developed multiple regression models for each measured forest biometric property using forward stepwise variable selection that used Bayesian information criteria (BIC) as selection criteria. Among measures of forest structure, ranging from tree lateral density, diameter at breast height, and crown geometry, we found strong relationships with lidar canopy vegetation profile parameters. Metrics developed from lidar that were indicators of height of canopy were not significant in estimating plot biomass (p-value = 0.31, r2 = 0.17), but parameters from our synthetic forest model were found to be significant for estimating many of the forest structural properties, such as mean trunk diameter (p-value = 0.004, r2 = 0.51) and tree density (p-value = 0.002, r2 = 0.43). We were also able to develop a significant model relating lidar profiles to basal area (p-value = 0.003, r2 = 0.43). Use of the full lidar profile provided additional avenues for the prediction of field based forest measure parameters. Our synthetic canopy model provides a novel method for examining lidar metrics by developing a look-up table of profiles that determine profile shape, depth, and height. We suggest that the use of metrics indicating canopy height derived from lidar are limited in understanding biomass in a forest with little variation across the landscape and that there are many parameters that may be gleaned by lidar data that inform on forest biometric properties

The association of reduced lung function with blood pressure variability in African Americans: data from the Jackson Heart Study

Background African Americans (AAs) have lower lung function, higher blood pressure variability (BPV) and increased risk for hypertension and cardiovascular disease (CVD) compared with whites. The mechanism through which reduced lung-function is associated with increased CVD risk is unclear. Methods We evaluated the association between percent predicted lung-function and 24-hour BPV in 1008 AAs enrolled in the Jackson Heart Study who underwent ambulatory blood pressure (BP) monitoring. Lung-function was assessed as forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and the ratio of FEV1-to-FVC during a pulmonary function test using a dry rolling sealed spirometer and grouped into gender-specific quartiles. The pairwise associations of these three lung-function measures with two measures of 24-hour BPV, (1) day-night standard deviation (SDdn) and (2) average real variability (ARV) were examined for systolic BP (SBP) and, separately, diastolic BP (DBP). Results SDdn of SBP was not associated with FEV1 (mean ± standard deviation from lowest-to-highest quartile: 9.5 ± 2.5, 9.4 ± 2.4, 9.1 ± 2.3, 9.3 ± 2.6; p-trend = 0.111). After age and sex adjustment, the difference in SDdn of SBP was 0.0 (95 % CI −0.4,0.4), −0.4 (95 % CI −0.8,0.1) and −0.3 (95 % CI −0.7,0.1) in the three progressively higher versus lowest quartiles of FEV1 (p-trend = 0.041). Differences in SDdn of SBP across FEV1 quartiles were not statistically significant after further multivariable adjustment. After multivariable adjustment, no association was present between FEV1 and ARV of SBP or SDdn and ARV of DBP or when evaluating the association of FVC and FEV1-to-FVC with 24-hour BPV. Conclusion Lung-function was not associated with increased 24-hour BPV

The Utility of Ambulatory Blood Pressure Monitoring for Diagnosing White Coat Hypertension in Older Adults

The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment

Evaluation of Criteria to Detect Masked Hypertension

The prevalence of masked hypertension, out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP)≥135/85 mmHg on ambulatory blood pressure monitoring (ABPM) among adults with clinic SBP/DBP<140/90 mmHg, is high. It is unclear who should be screened for masked hypertension. We derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut-points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mmHg and ≥217 mmHg and prehypertension status was 98.5%, 71.5% and 82.5%, respectively. Using NHANES data (n=11,778), we estimated that these thresholds would refer 118.6, 44.4 and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM

Differences in night-time and daytime ambulatory blood pressure when diurnal periods are defined by self-report, fixed-times, and actigraphy: Improving the Detection of Hypertension study

To determine whether defining diurnal periods by self-report, fixed-time or actigraphy produce different estimates of nighttime and daytime ambulatory blood pressure (ABP)

Sedentary behavior and subclinical atherosclerosis in African Americans: cross-sectional analysis of the Jackson heart study

BACKGROUND: Previous studies have reported conflicting results as to whether an association exists between sedentary time and cardiovascular disease (CVD) risk among African Americans. These studies, however, were limited by lack of consideration of sedentary behavior in leisure versus non-leisure settings. To elucidate this relation, we investigated the associations of television (TV) viewing time and occupational sitting with carotid intima-media thickness (CIMT), a subclinical atherosclerosis measure, in a community-based sample of African Americans. METHODS: We studied 3410 participants from the Jackson Heart Study, a single-site, community-based study of African Americans residing in Jackson, MS. CIMT was assessed by ultrasonography and represented mean far-wall thickness across right and left sides of the common carotid artery. TV viewing time, a measure of leisure sedentary behavior, and occupational sitting, a measure of non-leisure sedentary behavior, were assessed by questionnaire. RESULTS: In a multivariable regression model that included physical activity and CVD risk factors, longer TV viewing time (2-4 h/day and >4 h/day) was associated with greater CIMT (adjusted mean ± SE difference from referent [4 h/day; P-trend =0.001). In contrast, more frequent occupational sitting ('sometimes' and 'often/always') was associated with lower CIMT (adjusted mean ± SE difference from referent ['never/seldom']:-0.021 ± 0.009 mm for 'sometimes', and-0.018 ± 0.008 mm for 'often/always'; P-trend = 0.042). CONCLUSIONS: Longer TV viewing time was associated with greater CIMT, while occupational sitting was associated with lower CIMT. These findings suggest the role of sedentary behaviors in the pathogenesis of CVD among African Americans may vary by whether individuals engage in leisure versus non-leisure sedentary behaviors

Refractory Hypertension: Determination of Prevalence, Risk Factors and Comorbidities in a Large, Population-Based Cohort

Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68–5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40–3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32–3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare

Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality

Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes or controlled hypertension while treated with four or more antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD), and all-cause mortality. Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n = 2043) and without aTRH (n = 12,479) were included. aTRH was further categorized as controlled aTRH (≥4 medication classes and controlled hypertension) and uncontrolled aTRH (≥3 medication classes and uncontrolled hypertension). Over a median of 5.9, 4.4, and 6.0 years of follow-up, the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94–1.65), 1.69 (1.27–2.24), and 1.29 (1.14–1.46), respectively. Compared with controlled aTRH, uncontrolled aTRH was associated with CHD (hazard ratio, 2.33; 95% confidence interval, 1.21–4.48), but not stroke or mortality. Comparing controlled aTRH with no aTRH, risk of stroke, CHD, and all-cause mortality was not elevated. aTRH was associated with an increased risk for coronary heart disease and all-cause mortality