Assessment of cardiovascular risk factor awareness and accentuation of early detection among African-American college students

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POSTERS: Risk Factors/Global Assessment

icant predictors of controlled hypertension. The only factor that was significant was the initial systolic blood pressure, which showed a pvalue for trend ⬍ 0.002 across the quartiles. Initial SBP (mm Hg)

n

OR (95% CI)

⬍149 149–160 161–178 ⬎178

42 41 43 39

1.00 (0.98–1.03) 0.61 (0.20–1.81) 0.25 (0.09–0.69) 0.15 (0.05–0.43)

These data suggest that the only characteristic that significantly predicted blood pressure control in our clinic was the initial systolic blood pressure, in agreement with previous work. Aside from this finding, there were no characteristics in our population that could be identified that would explain why we obtain higher blood pressure control rates compared to the general population. Key Words: Risk Factors, Hypertension Control, Hypertension Specialist

P-568 APOPROTEIN E POLYMORPHISM AND MICROALBUMINURIA IN TYPE 2 DIABETIC PATIENTS Giovanni Gaudio, Pietro Margaroli, Alberto Schizzarotto, Attilio Cristallo, Ivano Cosini, Piermario Bossi, Sergio Masnaghetti, Franco Rotolo, Luigina Guasti. Department Internal Medicine, Bellini Hospital, Somma Lombardo, Varese, Italy; Department Internal Medicine, Inubria University, Varese, Varese, Italy. In humans apo E presents a genetic polymorphism, with three common alleles (e2, e3, e4) coding for three isoforms (E1, E2, E3). Apoprotein (Apo) E polymorphism has been associated with the development of atherosclerosis, being the allele E4 associated with increased cardiovascular risk. It is well known that diabetes is related with accelerated atherosclerosis and microalbuminuria is used to evaluate initial renal damage. The aim of this study was to determine whether Apo E polymorphism was associated with microalbuminuria in patients with type 2 diabetes and hypertension. Fifty consecutive patients (29 M, 21 F, mean age 56⫾ 12 years) were studied. All the subjects were on treatment with aceinhibitors and oral anti-diabetic drugs. Apo E 3/4 was found in 10 patients, the E 2/3 was found in 4 patients whereas the E 3/3 was observed in 36 patients. The lipid profile was as follows in the E 3/4 patients: total cholesterol 189.5⫾23 mg/dl, HDL 49⫾20 mg/dl, LDL 109⫾20 mg/dl, tryglicerides 154 ⫾76 mg/dl, whereas in the other group total cholesterol was 207⫾32 mg/dl, HDL was 53⫾14 mg/dl, LDL was 207⫾32 mg/dl and tryglicerides were 160⫾73 mg/dl. Sphygmomanometric and ambulatory blood pressures, the length of known diabetic disease and the glycemic profile were similar between the 10 patients with the E 3/4 and the other group of 40 subjects (4 with E 2/3 and 36 with E 3/3 genotype ). However, the E 3/4 patients showed higher microalbuminuria than the other group (Mann Withney U test: 10,8⫾ 32,82 mg/dl vs 0.3⫾ 0,48 p⬍.05). In conclusion, the renal damage in type 2 diabetic patients, expressed by microalbuminuria seems to be related with the Apo E polymorphism, being the E 3/4 heterozigosity an increased risk factor. Key Words: ApoE, hypertension, diabetes

AJH–May 2003–VOL. 16, NO. 5, PART 2

P-569 IMPROVEMENT OF RISK FACTOR MANAGEMENT AMONGST HYPERTENSIVE PATIENTS BY EDUCATING FAMILY PRACTITIONERS: THE ISRAELI BLOOD PRESSURE CONTROL (IBPC) PROGRAM Dov Gavish, Eyal Leibovitz, Chaim Yosefi, Dror Dicker, Reuven J Viskoper. Internal Medicine, Wolfson Medical Center, Holon, Israel; Internal Medicine, Barzilai Medical Center, Ashkelon, Israel; Internal Medicine, Rabin Medical Center (Golda Campus), Petah-Tikwa, Israel. The IBPC program was designed to improve risk factor control amongst hypertensive patients, without allocating patient treatment to specialized risk factor clinics. The program started in August 2000, and it was headed by authoritative figures in risk factor control in Israel. Family practitioners, each caring for 1000 to 5000 patients, were asked to join the program and register data of hypertensive patients. Each physician was allocated a small budget for program related expenses. The organizing committee scheduled meetings every 2 months, to report on the progress of the program, and to review the treatment guidelines. Each physician received the data analysis concerning his clinic, and a comparison to the other centers. After one year, the participants filled the follow-up data regarding the same patients. A total of 4742 patients from 30 centers were recruited for the registry. After 1 year, systolic and diastolic BP dropped by 5.2% (from 142⫾16 mmHg to 135⫾14 mmHg, p⬍0.001, and from 85⫾11 to 80⫾8 mmHg p⬍0.001 respectively). 46.5% had controlled BP (according JNC VI) at follow-up compared to 31.6% at baseline (p⬍0.001). 88% of the clinics had more patients reach the JNC VI goals than they did at baseline, and 78% had more than 35% of their patients achieve the goals (compared to 30% at baseline, p⬍0.001). LDL-c reduced from 134⫾35 mg/dL at baseline to 126⫾49 mg/dL (p⬍0.001) at follow-up, and 42.6% had LDL-c levels below the ATP-III recommended goals(compared to 31.5% at baseline, p⬍0.001). 94% of the clinics had more patients reach the ATP III goals than they did at baseline, and 66.6% pf the clinics had more than 35% of their patients achieve the goals (compared to 33% at baseline, p⬍0.001). The changes in blood pressure and lipid levels were achieved by enhancing adherence to perscribed treatment, increasing the number and dosage of BP and lipid lowering medications and improving lifestyle. The estimated 10year risk according to ATP 3 risk charts was reduced from 18.0 (6% 10-year risk) to 17.4 points (5% 10-year risk) in females (p⬍0.001) and from 16.9 points (25-30% 10-year risk) to 13.8 points (12-16% 10-year risk) in males (p⬍0.001). We demonstrated that a physician education program can improve the quality of treatment in high risk patients in the community. Key Words: community, risk factor control, physician education program

P-570 ASSESSMENT OF CARDIOVASCULAR RISK FACTOR AWARENESS AND ACCENTUATION OF EARLY DETECTION AMONG AFRICAN-AMERICAN COLLEGE STUDENTS T Kristopher Harrell, Nancy N Horton, Deborah S King, Marion R Wofford. Schools of Pharmacy and Medicine, University of Mississippi Medical Center, Jackson, MS; School of Healthcare Administration, Jackson State University, Jackson, MS. Mississippi dubiously ranks first in the nation in the number of deaths due to cardiovascular disease (CVD). Mississippi also ranks first in prevalence rates of obesity (24.3%) and diabetes (8.8%), which are clearly associated risks for the development of CVD. While overall CVD mortality rates have been declining, Mississippi African-American rates of death have not been improving at the same rate. The most disturbing data are those for younger African-Americans, who have a three to four times greater risk of CVD death than their white counterparts.

AJH–May 2003–VOL. 16, NO. 5, PART 2

The purpose of this study was to assess the awareness of CVD risk factors in students attending a historically African-American university, and to emphasize the need for early risk factor detection. Participants were assessed for CVD risk factors including blood pressure, height, and weight. An awareness questionnaire based on the CDC Behavioral Risk Factor Surveillance System (BRFSS) was also utilized to assess selfreported physical activity, dietary behaviors, and tobacco consumption. Students were given risk factor results and received individual education from health care professionals during the screening. The total number of students who completed the screening and questionnaire was 138 (with ages ranging from 17-29 and average age of 20.4 years). Of these, the average BMI was 26.34, and 21% of students had a BMI of ⬎ 30. A total of 79 students (56%) were considered overweight or obese (BMI⬎25). Mean systolic and diastolic blood pressures were 122.5 mm Hg and 73.4 mm Hg, respectively. On the self-reported questionnaire, 11 students (8%) reported smoking cigarettes some or every day and 21 students (15%) stated they did not participate in any physical activity. Only 23 students (17%) reported eating fruits on a daily basis, while 88 students (64%) reported visiting a health care provider in the past year for a checkup. As for awareness of risk factors, 21 (14%) students reported knowing blood pressure goals, while only 1 (0%) student reported knowing BMI goals. Data from this study support the need for increased awareness of CVD risk factors in the African-American college students attending this university. The data also suggest that more emphasis should be placed on early detection of all CVD risk factors to reduce alarming disparities among younger African-Americans. Key Words: Risk factors, Awareness, Disparities

P-571 PREVALENCE AND CONTROL OF CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE RENAL TRANSPLANT PATIENTS Munavvar Izhar, Rajesh Nambiar, Nahla Hasabou, Stephen Jensik, Gilberto Neri, William J Elliott, Henry R Black. Department of Preventive Medicine, Rush-Presbyterian-St.-Luke’s-Medical Center, Chicago, IL; Department of Internal Medicine, Cook County Hospital, Chicago, IL; Renal transplant surgery, Rush-Pres.-St.-Luke’s -Medical Center, Chicago, IL. Hypertension is a major risk factor that must be controlled to optimally reduce cardiovascular risk. Previous surveys of our tertiary hypertension referral clinic have shown a high prevalence of controlled hypertension (BP⬍140/90 mm Hg in 67% patients using HEDIS 3.5 criteria). To examine the prevalence and control of other risk factors, a chart survey was performed for 205 consecutive renal transplant patients meeting the HEDIS 3.5 criteria for inclusion. These patients were seen between Jan 2000 to November 2002 either at the renal tranplant clinic or the hypertension clinic at the Rush-Presbyterian-St.-Luke’s-Medical Center in Chicago. The goal levels for BMI are based on recommendations from the American Dietetic Association, those for the lipid panel are based on NCEP ATP III guidelines and for the diabetic contol, gudelines established by the ADA was used. The prevalence and control of risk factors other than hypertension in our tertiary hypertension clinic are as follows: The above data suggests that hypertension and kidney specialists commonly investigate risk factors other than hypertension and make a reasonable effort to control them. Similar data in non tranplant hypertensive patients has been presented from our center before. It appears that the contol of cardiovascular risk factors, especially the lipid panel is worse in our post transplant hypertensives. A possible explanation for this is the continued use of steroids and other immunosuppressives which adversely affect the glycemic and lipid status of the patient, thereby

POSTERS: Risk Factors/Global Assessment

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Cardiovascular Risk Factors in Renal Transplant Hypertension

Outcome Measures

Goal Control

Number of Charts Measured/ Possible

Prevalence

Control

BMI TOTAL CHOLESTEROL HDL LDL TRIGLYCERIDES HbA1C PROTEINURIA HOMOCYSTEINE

⬍27 ⬍200 mg/dl

200/205 205/205

97.56% 100%

23% 56%

⬍40 (M); ⬍50 (F) ⬍NCEP goal ⬍150 mg/dl ⬍7% ⬍250 mg/dl* ⬍14

205/205 205/205 205/205 52/205 40/205 31/205

100% 100% 100% 25.36% 19.5% 15%

32% 40% 45% 47% 2% 27%

* Proteinuria measured in 24 hr. collection

predisposing a difficulty in controlling these cardiovascular risk factors. A more aggressive approach in control of these risk factors is desirable by both the internists and the specialists. Key Words: Cardiovascular Risk Factors, Renal Transplant, Prevalence and Control

P-572 MILD RENAL INSUFFICIENCY - A CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS Munavvar Izhar, Renee Ellis, Gregory Singer, Gilberto Neri, William J Elliott, George L Bakris, Henry R Black. Department of Preventive Medicine, Rush-Presbyterian-St.-Luke’s-Medical Center, Chicago, IL; Department of Internal medicine, Yale University, New Haven, CT. Abnormalities of renal function have significant effects on cardiovascular outcomes in hypertensive patients. The objective of this study was to analyze the association of various cardiovascular risk factors with renal insufficiency in hypertensive patients seen in our hypertension clinic. We analyzed demographic, clinical and biochemical data from 325 essential hypertension patients referred to our tertiary referral clinic from Jan 2000 to Oct 2002. Abnormalities of renal function included mild chronic renal insufficiency and the presence of micro/macroalbuminuria. The presence of mild renal insufficiency was ascertained either by a serum creatinine ⱖ1.5mg/dl in men or ⱖ1.4 mg/dl in women, or a creatinine clearance estimated by the Cockroft-Gault formula or by a 24 hour urine collection. Microalbuminuria was detected by commercially available Micral test or 24 hour urine collection in some cases. Macroalbuminuria was detected by dipstick or 24 hour urine collection showing ⬎ 300 mg/dl. The mean age of the patients was 54.22 years (SD 13.35). There were 56.6% males and 43.4% females and 18% diabetics. The mean weight was 72.26 Kg (SD 12.33). The mean SBP was 148 mm Hg (SD 19) and the mean DBP was 86 mm Hg (SD 11). The mean serum creatinine was 1.12 mg/dl (SD 0.32). Patients with mild renal insufficiency were characterized by older age, elevated systolic and diastolic blood pressures, higher serum total cholesterol, LDL cholesterol and triglycerides and lower levels of HDL cholesterol and higher levels of urinary albumin excretion. The results are consistent with a growing body of evidence indicating that renal insufficiency is a marker for cardiovascular risk, much of which is remediable. Key Words: Risk factor, Hypertension