Lynne Braun - Academia.edu (original) (raw)
Papers by Lynne Braun
Hypertension, 2015
Background: Rush Heart Center for Women (RHCW) opened in October 2003 to provide a multidisciplin... more Background: Rush Heart Center for Women (RHCW) opened in October 2003 to provide a multidisciplinary approach (MDA) for female patients (pts). RHCW provided personalized care plans to address women’s heart health, with an emphasis on female-specific risk factors and symptoms. MDA including cardiologists, dietitians and nurse practitioners to treat female pts was compared to a similar cohort using standard practice in terms of HTN treatment. Methods: A retrospective study identified pts with HTN treated at RHCW using a MDA and compared to a cohort of pts treated by cardiologists and received a standard level of care consistent with guidelines and recommendations (standard practice). Pts seen between 2008 and 2014 with at least 2 visits between 9 and 15 months apart were studied. Demographic moderating variables were race, age, and insurance. Moderating clinical variables were baseline systolic BP, body mass index, diabetes, smoking status, history of coronary disease, stroke, and pri...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2013
Introduction Elevated lipoprotein (a) (Lpa) has been linked repeatedly with cardiovascular diseas... more Introduction Elevated lipoprotein (a) (Lpa) has been linked repeatedly with cardiovascular disease (CVD) events. Two models of the Reynold’s Risk Score (RRS) A & B were validated to be effective predictors of CVD events. Lpa was included in RRS A but was excluded in RRS B. We sought to determine the proportion of patients (pts) that are reclassified into a different risk category utilizing RRS A instead of the simplified RRS B. Methods Female pts with Lpa and data for RRS seen from 2006-12 at the Heart Centers for Women at RUMC and Emory Healthcare were included. Charts were reviewed for pt characteristics and biomarkers using Berkeley Heart Lab including: Total, LDL, and HDL cholesterol, triglycerides, ApoB, Lpa, HS-CRP, HgB A 1 c and history of hypertension, diabetes, current smoking, family history and blood pressure. HDL was substituted for ApoA 1 in all cases in RRS A. RRS A and B were calculated. The proportions of pts within different risk strata were compared between the two...
Circulation, 2021
Doctorally prepared nurse scholars with the doctor of nursing practice (DNP) and the doctor of ph... more Doctorally prepared nurse scholars with the doctor of nursing practice (DNP) and the doctor of philosophy (PhD) degrees are equally well suited to engage in scholarship to advance cardiovascular nursing and health outcomes. Collaboration between DNP and PhD scholars is crucial to develop interventions to improve cardiovascular outcomes and encourage efficient translation of research findings into practice. The purpose of this paper is to (1) provide a targeted review of the current state of literature on examples of DNP-PhD collaboration, and (2) describe ongoing DNP-PhD collaborations across three NIH-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. First, a targeted review was conducted to identify examples of DNP-PhD collaboration, and identified 12 published articles. Articles described the DNP-PhD collaborations in research/scholarship ( n = 8) and education ( n = 5). Of the research articles, there was...
Circulation, 2018
Background: Increased detection of heart disease in women has been advocated nationally in recent... more Background: Increased detection of heart disease in women has been advocated nationally in recent years. The atherosclerotic cardiovascular disease (ASCVD) risk score was validated as determinant of the 10-year risk for first occurrence of nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke in 2013. While measurement of blood pressure, glucose, and lipid levels are common in screening, the utility of non-traditional methods such as electrocardiogram (ECG) and transthoracic echocardiography (TTE) remains unknown. We examined the association of ECG and TTE abnormalities with ASCVD risk score among asymptomatic women from a community-based event. Methods: Data were gathered from 355 women (mean age 53±13 years, 24.2% African American, 59.7% Caucasian, 6.2% Hispanic, 9.9% Others) from a voluntary cardiovascular community screening event sponsored by the 2BigHearts Foundation and Rush University Medical Center in February 2007 and May 2008. Demograph...
Facilitators • Sense of Community: “Even when I don’t have an appointment sometimes, to tell you ... more Facilitators • Sense of Community: “Even when I don’t have an appointment sometimes, to tell you the truth, I just come-up here and sit in the lobby, listening and talking to people” (P19). • Mutual Participant-Provider Respect: ““[T]hey treat me, you know, with the kind of respect that I feel like anybody deserves to be treated with” (P15). • Financial Assurance: “[O]ne thing about them over here at [this clinic]...when you give your card, that’s it, they don’t ask you for no, nothing else” (P13). • Integrated Health Services: ““They just have a lot of resources...if you depressed, sufferin’ from mental illness, like me, they got some of the best psychiatrists, and therapists. Nutritionists... Ain’t nowhere else you need to go” (P19). • Participant Care Teams: “I do have a substance problem, and I talk to my primary care physician, slash counselor, slash friend, and I have another therapist here that I talk to...we have about six, seven people that’s helpin’ us now” (P4).
Contemporary Clinical Trials, 2021
Introduction: Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affec... more Introduction: Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition. Methods: The study design is a randomized controlled trial with a 2x2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1)Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks.
2353 C ardiovascular disease (CVD) is the leading cause of death in the United States. 1 Despite ... more 2353 C ardiovascular disease (CVD) is the leading cause of death in the United States. 1 Despite efforts promoting primary and secondary CVD prevention, 2–8 obesity and physical inactivity remain at epidemic proportions, with >60% of Americans adults overweight or obese and >50% not performing recommended levels of physical activity. 9 Similarly, hypertension, hypercho-lesterolemia, and other CVD risk factors remain poorly controlled in many Americans. Despite numerous pharmacological and device-based advances in the management of patients with established CVD, morbidity and mortality associated with this condition remain substantial. Hence, a critical need exists for novel strategies and interventions that can potentially reduce the risk of CVD and its attendant morbidity and mortality. Numerous studies have explored the relationship between pet (primarily dog or cat) ownership and CVD, with many reporting beneficial effects, including increased physical activity , favorable ...
Background: Heart failure (HF) is the number one reason for hospitalization, and over 25% of hosp... more Background: Heart failure (HF) is the number one reason for hospitalization, and over 25% of hospitalized HF patients are readmitted within 30-days. Many HF readmissions are preventable with improv...
Nursing Research, 2021
Background: African American women have lower levels of leisure-time physical activity compared t... more Background: African American women have lower levels of leisure-time physical activity compared to White American women. Interventions to improve physical activity have mixed benefits for African American women, even when guided by theory. Understanding how theoretical constructs used in physical activity interventions relate to changing behavior may provide direction for more successful interventions. Objective: The study aimed to examine the relationships among social cognitive constructs (selfefficacy, social support from group behavioral meetings, outcome expectations/realizations), and change in physical activity from baseline to 48 weeks in African American women participating in a lifestyle physical activity program. Methods: A secondary data analysis of longitudinal data using a correlational design was conducted using data from a 48-week physical activity randomized controlled trial (RCT). The RCT included a group behavioral meeting component with one of three telephone intervention conditions (no calls, personal motivation calls, or automated motivational calls) randomly assigned across six community health care sites. The participants were 260 sedentary, midlife African American women with no major signs or symptoms of cardiovascular disease who completed baseline and 48-week assessments of the RTC. Measures included self-efficacy for change in overcoming barriers to physical activity at 24 weeks, physical and psychological-outcome realizations at 24 weeks, social support from group behavioral meetings at 24 weeks, and physical activity (self-report and device-measured) change from baseline to 48 weeks. Results: In a hierarchical regression model predicting change in self-reported time spent in weekly moderate-vigorous physical activity (MVPA) at 48 weeks, psychological-outcome realizations at 24 weeks were significant positive predictors. In a hierarchical regression model for change in device-measured daily steps at 48 weeks, a self-efficacy change at 24 weeks was a significant positive predictor.
Circulation, 2021
At a population level, engagement in healthy lifestyle behaviors is suboptimal in the United Stat... more At a population level, engagement in healthy lifestyle behaviors is suboptimal in the United States. Moreover, marked disparities exist in healthy lifestyle behaviors and cardiovascular risk factors as a result of social determinants of health. In addition, there are specific challenges to engaging in healthy lifestyle behaviors related to age, developmental stage, or major life circumstances. Key components of a healthy lifestyle are consuming a healthy dietary pattern, engaging in regular physical activity, avoiding use of tobacco products, habitually attaining adequate sleep, and managing stress. For these health behaviors, there are guidelines and recommendations; however, promotion in clinical settings can be challenging, particularly in certain population groups. These challenges must be overcome to facilitate greater promotion of healthy lifestyle practices in clinical settings. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for...
Mayo Clinic Proceedings, 2021
Review of the US and European literature indicates that most patients at high risk for atheroscle... more Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater. A subgroup of patients with ASCVD are at very high risk and can benefit by the addition of nonstatin drugs (ezetimibe with or without bile acid sequestrant or bempedoic acid and/or a proprotein convertase subtilisin/kexin type 9 inhibitor). High-risk primary prevention patients are those with severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater. In patients with a 10-year risk of 7.5% to less than 20%, coronary artery calcium scoring is an option; if the coronary artery calcium score is 300 or more Agatston units, the patient can be up-classified to high risk. If high-intensity statin treatment is not tolerated in high-risk patients, a reasonable approach is to combine a moderate-intensity statin with ezetimibe. In very high-risk patients, proprotein convertase subtilisin/kexin type 9 inhibitors lower low-density lipoprotein cholesterol levels substantially and hence reduce risk as well.
Progress in Cardiovascular Diseases, 2021
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortali... more Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.
Journal of Women's Health, 2020
Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophys... more Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophysiological basis that differentially affects various organs in some patients. The prevalence of small-vessel disease in the heart has been found to be higher in women compared with men. Additionally, other diseases prominently affecting women, including heart failure with preserved ejection fraction, Takotsubo cardiomyopathy, cerebral small-vessel disease, preeclampsia, pulmonary arterial hypertension (PAH), endothelial dysfunction in diabetes, diabetic cardiomyopathy, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, may have a common etiologic linkage related to microvascular disease. To the best of our knowledge this is the first article to investigate this potential linkage. We sought to identify various diseases with a shared pathophysiology involving microvascular/endothelial dysfunction that primarily affect women, and their potential implications for disease management. Advanced imaging technologies, such as magnetic resonance imaging and positron-emission tomography, enable the detection and increased understanding of microvascular dysfunction in various diseases. Therapies that improve endothelial function, such as those used in PAH, may also be associated with benefits across the full spectrum of microvascular dysfunction. A shared pathology across multiple organ systems highlights the need for a collaborative, multidisciplinary approach among medical subspecialty practitioners who care for women with small-vessel disease. Such an approach may lead to accelerated research in diseases that affect women and their quality of life.
Cardiovascular Revascularization Medicine, 2018
American Journal of Lifestyle Medicine, 2018
The aim of this study was to test the effects of a lifestyle physical activity intervention (grou... more The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, w...
Journal of the American Heart Association, 2019
Circulation, Jan 29, 2016
The American Heart Association makes every effort to avoid any actual or potential conflicts of i... more The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
Hypertension, 2015
Background: Rush Heart Center for Women (RHCW) opened in October 2003 to provide a multidisciplin... more Background: Rush Heart Center for Women (RHCW) opened in October 2003 to provide a multidisciplinary approach (MDA) for female patients (pts). RHCW provided personalized care plans to address women’s heart health, with an emphasis on female-specific risk factors and symptoms. MDA including cardiologists, dietitians and nurse practitioners to treat female pts was compared to a similar cohort using standard practice in terms of HTN treatment. Methods: A retrospective study identified pts with HTN treated at RHCW using a MDA and compared to a cohort of pts treated by cardiologists and received a standard level of care consistent with guidelines and recommendations (standard practice). Pts seen between 2008 and 2014 with at least 2 visits between 9 and 15 months apart were studied. Demographic moderating variables were race, age, and insurance. Moderating clinical variables were baseline systolic BP, body mass index, diabetes, smoking status, history of coronary disease, stroke, and pri...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2013
Introduction Elevated lipoprotein (a) (Lpa) has been linked repeatedly with cardiovascular diseas... more Introduction Elevated lipoprotein (a) (Lpa) has been linked repeatedly with cardiovascular disease (CVD) events. Two models of the Reynold’s Risk Score (RRS) A & B were validated to be effective predictors of CVD events. Lpa was included in RRS A but was excluded in RRS B. We sought to determine the proportion of patients (pts) that are reclassified into a different risk category utilizing RRS A instead of the simplified RRS B. Methods Female pts with Lpa and data for RRS seen from 2006-12 at the Heart Centers for Women at RUMC and Emory Healthcare were included. Charts were reviewed for pt characteristics and biomarkers using Berkeley Heart Lab including: Total, LDL, and HDL cholesterol, triglycerides, ApoB, Lpa, HS-CRP, HgB A 1 c and history of hypertension, diabetes, current smoking, family history and blood pressure. HDL was substituted for ApoA 1 in all cases in RRS A. RRS A and B were calculated. The proportions of pts within different risk strata were compared between the two...
Circulation, 2021
Doctorally prepared nurse scholars with the doctor of nursing practice (DNP) and the doctor of ph... more Doctorally prepared nurse scholars with the doctor of nursing practice (DNP) and the doctor of philosophy (PhD) degrees are equally well suited to engage in scholarship to advance cardiovascular nursing and health outcomes. Collaboration between DNP and PhD scholars is crucial to develop interventions to improve cardiovascular outcomes and encourage efficient translation of research findings into practice. The purpose of this paper is to (1) provide a targeted review of the current state of literature on examples of DNP-PhD collaboration, and (2) describe ongoing DNP-PhD collaborations across three NIH-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. First, a targeted review was conducted to identify examples of DNP-PhD collaboration, and identified 12 published articles. Articles described the DNP-PhD collaborations in research/scholarship ( n = 8) and education ( n = 5). Of the research articles, there was...
Circulation, 2018
Background: Increased detection of heart disease in women has been advocated nationally in recent... more Background: Increased detection of heart disease in women has been advocated nationally in recent years. The atherosclerotic cardiovascular disease (ASCVD) risk score was validated as determinant of the 10-year risk for first occurrence of nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke in 2013. While measurement of blood pressure, glucose, and lipid levels are common in screening, the utility of non-traditional methods such as electrocardiogram (ECG) and transthoracic echocardiography (TTE) remains unknown. We examined the association of ECG and TTE abnormalities with ASCVD risk score among asymptomatic women from a community-based event. Methods: Data were gathered from 355 women (mean age 53±13 years, 24.2% African American, 59.7% Caucasian, 6.2% Hispanic, 9.9% Others) from a voluntary cardiovascular community screening event sponsored by the 2BigHearts Foundation and Rush University Medical Center in February 2007 and May 2008. Demograph...
Facilitators • Sense of Community: “Even when I don’t have an appointment sometimes, to tell you ... more Facilitators • Sense of Community: “Even when I don’t have an appointment sometimes, to tell you the truth, I just come-up here and sit in the lobby, listening and talking to people” (P19). • Mutual Participant-Provider Respect: ““[T]hey treat me, you know, with the kind of respect that I feel like anybody deserves to be treated with” (P15). • Financial Assurance: “[O]ne thing about them over here at [this clinic]...when you give your card, that’s it, they don’t ask you for no, nothing else” (P13). • Integrated Health Services: ““They just have a lot of resources...if you depressed, sufferin’ from mental illness, like me, they got some of the best psychiatrists, and therapists. Nutritionists... Ain’t nowhere else you need to go” (P19). • Participant Care Teams: “I do have a substance problem, and I talk to my primary care physician, slash counselor, slash friend, and I have another therapist here that I talk to...we have about six, seven people that’s helpin’ us now” (P4).
Contemporary Clinical Trials, 2021
Introduction: Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affec... more Introduction: Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition. Methods: The study design is a randomized controlled trial with a 2x2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1)Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks.
2353 C ardiovascular disease (CVD) is the leading cause of death in the United States. 1 Despite ... more 2353 C ardiovascular disease (CVD) is the leading cause of death in the United States. 1 Despite efforts promoting primary and secondary CVD prevention, 2–8 obesity and physical inactivity remain at epidemic proportions, with >60% of Americans adults overweight or obese and >50% not performing recommended levels of physical activity. 9 Similarly, hypertension, hypercho-lesterolemia, and other CVD risk factors remain poorly controlled in many Americans. Despite numerous pharmacological and device-based advances in the management of patients with established CVD, morbidity and mortality associated with this condition remain substantial. Hence, a critical need exists for novel strategies and interventions that can potentially reduce the risk of CVD and its attendant morbidity and mortality. Numerous studies have explored the relationship between pet (primarily dog or cat) ownership and CVD, with many reporting beneficial effects, including increased physical activity , favorable ...
Background: Heart failure (HF) is the number one reason for hospitalization, and over 25% of hosp... more Background: Heart failure (HF) is the number one reason for hospitalization, and over 25% of hospitalized HF patients are readmitted within 30-days. Many HF readmissions are preventable with improv...
Nursing Research, 2021
Background: African American women have lower levels of leisure-time physical activity compared t... more Background: African American women have lower levels of leisure-time physical activity compared to White American women. Interventions to improve physical activity have mixed benefits for African American women, even when guided by theory. Understanding how theoretical constructs used in physical activity interventions relate to changing behavior may provide direction for more successful interventions. Objective: The study aimed to examine the relationships among social cognitive constructs (selfefficacy, social support from group behavioral meetings, outcome expectations/realizations), and change in physical activity from baseline to 48 weeks in African American women participating in a lifestyle physical activity program. Methods: A secondary data analysis of longitudinal data using a correlational design was conducted using data from a 48-week physical activity randomized controlled trial (RCT). The RCT included a group behavioral meeting component with one of three telephone intervention conditions (no calls, personal motivation calls, or automated motivational calls) randomly assigned across six community health care sites. The participants were 260 sedentary, midlife African American women with no major signs or symptoms of cardiovascular disease who completed baseline and 48-week assessments of the RTC. Measures included self-efficacy for change in overcoming barriers to physical activity at 24 weeks, physical and psychological-outcome realizations at 24 weeks, social support from group behavioral meetings at 24 weeks, and physical activity (self-report and device-measured) change from baseline to 48 weeks. Results: In a hierarchical regression model predicting change in self-reported time spent in weekly moderate-vigorous physical activity (MVPA) at 48 weeks, psychological-outcome realizations at 24 weeks were significant positive predictors. In a hierarchical regression model for change in device-measured daily steps at 48 weeks, a self-efficacy change at 24 weeks was a significant positive predictor.
Circulation, 2021
At a population level, engagement in healthy lifestyle behaviors is suboptimal in the United Stat... more At a population level, engagement in healthy lifestyle behaviors is suboptimal in the United States. Moreover, marked disparities exist in healthy lifestyle behaviors and cardiovascular risk factors as a result of social determinants of health. In addition, there are specific challenges to engaging in healthy lifestyle behaviors related to age, developmental stage, or major life circumstances. Key components of a healthy lifestyle are consuming a healthy dietary pattern, engaging in regular physical activity, avoiding use of tobacco products, habitually attaining adequate sleep, and managing stress. For these health behaviors, there are guidelines and recommendations; however, promotion in clinical settings can be challenging, particularly in certain population groups. These challenges must be overcome to facilitate greater promotion of healthy lifestyle practices in clinical settings. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for...
Mayo Clinic Proceedings, 2021
Review of the US and European literature indicates that most patients at high risk for atheroscle... more Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater. A subgroup of patients with ASCVD are at very high risk and can benefit by the addition of nonstatin drugs (ezetimibe with or without bile acid sequestrant or bempedoic acid and/or a proprotein convertase subtilisin/kexin type 9 inhibitor). High-risk primary prevention patients are those with severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater. In patients with a 10-year risk of 7.5% to less than 20%, coronary artery calcium scoring is an option; if the coronary artery calcium score is 300 or more Agatston units, the patient can be up-classified to high risk. If high-intensity statin treatment is not tolerated in high-risk patients, a reasonable approach is to combine a moderate-intensity statin with ezetimibe. In very high-risk patients, proprotein convertase subtilisin/kexin type 9 inhibitors lower low-density lipoprotein cholesterol levels substantially and hence reduce risk as well.
Progress in Cardiovascular Diseases, 2021
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortali... more Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.
Journal of Women's Health, 2020
Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophys... more Microvascular disease, or small-vessel disease, is a multisystem disorder with a common pathophysiological basis that differentially affects various organs in some patients. The prevalence of small-vessel disease in the heart has been found to be higher in women compared with men. Additionally, other diseases prominently affecting women, including heart failure with preserved ejection fraction, Takotsubo cardiomyopathy, cerebral small-vessel disease, preeclampsia, pulmonary arterial hypertension (PAH), endothelial dysfunction in diabetes, diabetic cardiomyopathy, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, may have a common etiologic linkage related to microvascular disease. To the best of our knowledge this is the first article to investigate this potential linkage. We sought to identify various diseases with a shared pathophysiology involving microvascular/endothelial dysfunction that primarily affect women, and their potential implications for disease management. Advanced imaging technologies, such as magnetic resonance imaging and positron-emission tomography, enable the detection and increased understanding of microvascular dysfunction in various diseases. Therapies that improve endothelial function, such as those used in PAH, may also be associated with benefits across the full spectrum of microvascular dysfunction. A shared pathology across multiple organ systems highlights the need for a collaborative, multidisciplinary approach among medical subspecialty practitioners who care for women with small-vessel disease. Such an approach may lead to accelerated research in diseases that affect women and their quality of life.
Cardiovascular Revascularization Medicine, 2018
American Journal of Lifestyle Medicine, 2018
The aim of this study was to test the effects of a lifestyle physical activity intervention (grou... more The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, w...
Journal of the American Heart Association, 2019
Circulation, Jan 29, 2016
The American Heart Association makes every effort to avoid any actual or potential conflicts of i... more The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.