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Berenson G.S.,Tulane Center for Cardiovascular Health
Preventive Cardiology | Year: 2010

Cardiovascular (CV) risk factors in childhood result in a lifetime burden on the CV system. The Bogalusa Heart Study, a prevention program for children, addresses behaviors and lifestyles associated with CV risk. This prevention program utilizes the substructure of a Parish (County) that can be a model for other areas. All aspects in educating school children-the classroom, physical activity, cafeteria, teachers, and parents with community involvement-are included. The program requires cooperation of parents, schools, physicians, and political and business personnel. Their collaboration helps implement and sustain the program. Understanding the origin of coronary artery disease, hypertension, diabetes, and now the obesity epidemic shows the need to develop a framework for improving lifestyles and behaviors beginning in childhood. In addition to nutrition and exercise, the program addresses tobacco, alcohol, and drug use, and societal problems such as dropping out of school, violent behavior, and teenage pregnancy. An initial accomplishment is the entry into all elementary schools, representing approximately 7000 children. Early results show reduction in obesity, increased physical activity, improved decision making, and healthy attitudes. This public health model is inexpensive by utilizing prior research findings and integrating into community resources. Health education of children is an important aspect of preventive cardiology with a need for pediatric and adult cardiologists' involvement.Prev Cardiol. © 2009 Wiley Periodicals, Inc. Source

Abul Y.,Ministry of Health Bismil Government Hospital | Karakurt S.,Marmara University | Ozben B.,Marmara University | Toprak A.,Tulane Center for Cardiovascular Health | Celikel T.,Ministry of Health Bismil Government Hospital
Journal of Investigative Medicine | Year: 2011

Background: Right ventricular dysfunction and N-terminal proB-type natriuretic peptide (NT-proBNP) are established determinants of prognosis in acute pulmonary embolism (PE). The aim of the study was to investigate the prognostic value of C-reactive protein (CRP) in PE. Methods: Fifty-six patients (mean age, 64.4 ± 14.8years; 22 male subjects) with acute PE were consecutively enrolled and followed for 36 months after discharge. Serum CRP, NT-proBNP, and troponin T levels were determined. Right ventricular function was evaluated by transthoracic echocardiography. Results: Right ventricular dysfunction was present in 31 patients and was more frequent in patients with higher CRP and NT-proBNP levels (P = 0.020 and P = 0.045, respectively). During the 36-month follow-up, there were 15 terminal events (death due to recurrent PE). The mortality rate was 41.2% in patients with NT-proBNP levels greater than 1000 pg/mL, whereas it was 5.9% in patients with less than 500 pg/mL (P = 0.011). Mortality rates also were higher in patients with elevated CRP and troponin T levels, but the differences did not reach clinical significance. The survival rate of acute PE patients with lower NT-proBNP and CRP levels was better than that of patients with higher NT-proBNP and CRP levels. Receiver operating characteristic curve analysis demonstrated cutoff values for NT-proBNP as 1800 pg/mL (sensitivity, 93.3%; specificity, 68.2%; positive predictive values, 66.7%; and negative predictive values, 93.8%) and for CRP as 48mg/L (sensitivity, 72.7%; specificity, 61.9%; positive predictive values, 50.0%; and negative predictive values, 81.3%) to predict mortality in PE patients. Conclusions: C-reactive protein is associated with right ventricular dysfunction, which is a predictor of prognosis in PE and may become a promising biomarker for risk stratification of PE, although CRP is not found superior to NT-proBNP. Copyright © 2011 American Federation for Medical Research.. Source

Levy-Marchal C.,French Institute of Health and Medical Research | Levy-Marchal C.,University Paris Diderot | Arslanian S.,University of Pittsburgh | Cutfield W.,University of Auckland | And 35 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Objective: Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. Participants: The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. Evidence: An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. Consensus Process: The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. Conclusions: Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases. Copyright © 2010 by The Endocrine Society. Source

Abul Y.,Karadeniz Technical University | Ozsu S.,Karadeniz Technical University | Karakurt S.,Marmara University | Ozben B.,Marmara University | And 4 more authors.
Cardiology Journal | Year: 2013

Background: The evaluation of right ventricular (RV) dysfunction by echocardiography is one of the most important established determinants of the prognosis of acute pulmonary embolism. The aim of the study was to investigate possible association between diameter of right descending pulmonary artery on chest X-rays and RV dysfunction by echocardiography in hemodynamically stable pulmonary embolism patients. Methods: Eighty-nine patients with the diagnosis of hemodynamically stable pulmonary embolism were included. Results: The frequency of RV dysfunction was significantly higher in patients with an enlarged right descending pulmonary artery on chest X-rays (p = 0.001). There was a significant positive correlation between the diameter of the right descending pulmonary artery on postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameter of right descending pulmonary artery on chest X-rays was also found as a significant predictor of RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05). Conclusions: Diameter of right descending pulmonary artery on chest X-rays may provide information about the risk for pulmonary embolism patients and may be used as a prognostic radiological parameter for the appropriate management of acute pulmonary embolism. © 2013 Via Medica. Source

Lai C.-C.,Tulane Center for Cardiovascular Health | Lai C.-C.,Peking Union Medical College | Sun D.,Tulane Center for Cardiovascular Health | Sun D.,Peking University | And 7 more authors.
Journal of the American College of Cardiology | Year: 2014

Background Cardiovascular risk factors are associated with left ventricular hypertrophy (LVH), but little is known regarding related impact of longitudinal measures of childhood adiposity and LV hemodynamic variables.Objectives The aim of this study was to examine the impact of cumulative long-term burden and trends of excessive adiposity and elevated blood pressure (BP) during childhood on adulthood LVH and LV geometric remodeling patterns.Methods This longitudinal study consisted of 1,061 adults, age 24 to 46 years, who had been examined 4 or more times for body mass index (BMI) and BP starting in childhood, with a mean follow-up of 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and BP from childhood to adulthood. Four LV geometric types were defined - normal, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH) - all on the basis of LV mass indexed for body height (m2.7) and relative wall thickness.Results Higher values of BMI and systolic and diastolic BP in childhood and adulthood, as well as total AUC and incremental AUC, were all significantly associated with higher LV mass index and LVH, adjusted for race, sex, and age. In addition, higher values of BMI and BP in childhood and adulthood, total AUC, and incremental AUC were significantly associated with EH and CH but not with CR. Importantly, all of these measures of BMI had a consistently and significantly greater influence on EH than did measures of BP.Conclusions These findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LVH begins in childhood. © 2014 American College of Cardiology Foundation. Source

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