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Background: Few studies have examined the relationship between heavy metal and serum cholesterol levels, and no recent study has examined this relationship in the US population. Methods and Results: A total of 19,591 individuals aged 0–80 years were included in the National Health and Nutrition Examination Survey 2009–2012; the current study was composed of survey participants for whom some or all low-density lipoprotein cholesterol (LDL-C), serum triglyceride, high-density lipoprotein cholesterol, total cholesterol, blood lead (Pb), total blood mercury (Hg), and blood cadmium (Cd) levels had been measured. Three tertiles (T1–T3) of heavy metals were used to explore dose–response association between heavy metal exposure and serum cholesterol level. Logistic regression was used to explore the relationship between tertiles of blood heavy metal levels and serum cholesterol levels after adjusting for age, sex, and socioeconomic status. We have shown that the groups with the highest levels of Pb, Hg, and Cd had a 56%, 73%, and 41% chance, respectively, of having a high total cholesterol level. In study subjects with the highest Pb levels, there was also a 22% chance of being in the group with the highest LDL-C level. An increase in total cholesterol and LDL-C levels was observed from the first to the third tertiles of the heavy metals studied. Conclusion: Increasing blood Pb, Hg, and Cd levels were associated with significantly increased odds of high total cholesterol after adjusting for age, sex, and socioeconomic status.

Introduction: Congestive heart failure (CHF) remains an epidemic with rising prevalence and a contributing cause of 1 in 9 deaths in the United States. An understanding of internet search engines for congestive heart failure as informational and initial diagnostic tools may enable targeted education strategies. Hypothesis: There is a correlation between CHF google search and outcomes. Methods: We used google trends, a publicly available google tool, to identify search frequency for CHF and related terms like early signs of heart failure, congestive heart failure facts over a 2 year period from 2014-2016 across regions of the United States. We then evaluated the prevalence of hospitalization and mortality rates among Medicare beneficiaries based on Center for Disease Control (CDC) data. Utilizing Pearson correlation (R) test, we determined the association between relative search frequency (RSF) in various states versus CHF hospitalization and mortality rates. Results: Across the 50 states in United States, there were 25 searches related to the search terms. There was a moderate positive correlation (R 0.4-0.7) between CHF hospitalization (R= 0.43) and mortality (R=0.51) with relative search frequency in google trends. Conclusions: We demonstrated a correlation between internet search and CHF prevalence and hospitalization. The emergence of data analytics in CHF care may enable greater understanding of patient questions in CHF to better target education and prevention.

Sickle cell disease (SCD) predominantly affects African-Americans (AAs) in the United States (US). Due to increasing life expectancy in developed countries, SCD-associated cardiomyopathy is typically seen in adults. The aim of this study was to distinguish hospitalization for this phenotype from traditional heart failure (HF) in AAs. We used the National Inpatient Sample (NIS) database to identify HF hospitalizations in AAs between 2005 and 2014 and stratified them according to SCD status. We compared the characteristics and outcomes before and after matching in a 1:3 ratio for age, gender, insurance, smoking status and admission year. Amongst the 1,195,718 HF admissions in AAs, SCD accounted for 7835. The age (mean ± SD) in the SCD cohort was significantly younger (45.66 ± 13.2) vs non-SCD (64.8 ± 15.2), p

Introduction: Hypertension is a significant risk factor for cardiovascular morbidity and mortality. According to the recent guideline, the criteria for diagnosing hypertension is now 130/80mmhg. This study seeks to gain a better understanding of the prevalence of hypertension, its awareness, and control in the United States population over the last 10 years using the new criteria for hypertension. Methods: NHANES is a stratified multistage probability sampling of the civilian noninstitutionalized population of the United States. We used the last five cycles available (2007-2016) to conduct a prevalence study applying statistical methods to account for the survey technique and non-response. Result: The mean age was 47.33 years (95%CI, 46.82-29.09), females constituted 51.9% of the population(n=28147), non-Hispanic white 66.63%, non-Hispanic black, 11.40%, Mexican American 8.55%. About 39% of the population studied were obese (BMI greater than or equal to 30). The crude ten years prevalence of hypertension was 38.85%, there was an increasing trend from 37.58% in the 2007-2008 cycle to 41.12% in the 2015-2016 cycle; this increase is statistically significant Conclusion: We were able to demonstrate the significant increase in hypertension prevalence with an increasing trend based on the new guidelines. Also, there is a downward trend in awareness and control; we have demonstrated again, the significant racial disparities in hypertension with about half of the black population being hypertensive. Our study showed that there is a need to intensify effort to combat this epidemic.

Background: Ambulatory health care visits (HCVs) have substantial impact on heart failure (HF) outcomes. We tested the hypothesis that the number of HCVs vary by race, insurance status and other socioeconomic status (SES) factors among both hospitalized and non-hospitalized HF patients. Methods: Using the United States NHANES 2005-2016 database, 1154 individuals with HF were identified based on reported diagnosis. Multivariate logistic regression using the proportional odds model was performed with number of HCVs in 12 months as the dependent variable. Age, race, sex, educational status, income and insurance status were the independent variables. Survey procedures that account for the weighted, clustered sampling design, and non-response were used in the analysis. Results: Mean age of the sample was 67 years; including 51% females. Non-Hispanic whites, non-Hispanic blacks, and Hispanics accounted for 70 %, 16%, and 5% of the population, respectively. Multivariate analysis revealed that patients with insurance had a 2.5 greater odds of having more HCV compared to uninsured patients (OR 2.49,1.34-4.63 P=0.0042). There were no differences in women compared to men(OR 1.13, 0.84-1.51 P=0.42), Non-Hispanic whites compared to Hispanics (OR 1.183, 0.701-1.996 P=0.26), or people without a high school degree compared to those with a degree,(OR 1.343, 0.873-2.067 P=0.2815). Conclusions: Current analysis suggests an association between insurance status and number of HCVs. Unlike previous reports that considered hospitalized patients alone, the current analysis does not reveal significant racial or gender disparities.

Prostate cancer is the most commonly diagnosed visceral cancer in the United States. A majority of cases exhibit an insidious course and nonaggressive tumor behavior. Prostate cancer can manifest as lesions which remain localized, regionally invading or metastasize to lymph nodes, bones, and lungs. Here, we report a unique case of metastatic prostate cancer to the right upper mediastinum, presenting as a paravertebral mass within 2 years of initial tissue diagnosis. Paravertebral spread has not been described for prostate cancer, and herein, we discuss the clinical presentation, diagnostic workup, and possible therapeutic options available in light of the literature.

Heart failure (HF) is a common cause of hospitalization in the United States. Cardiac amyloidosis (CA) has become a more widely accepted cause of HF hospitalizations in the US, however there remains limited data about this patient population largely due to its under-recognition. This study aimed to

There is limited information about variations in admission rate and outcomes in patients admitted with Acute coronary syndrome(ACS). Our study seeks to explore this gap; its importance in clinical and resource planning cannot be overemphasized. Using the National inpatient sample(NIS), we tested

Mesoamerican nephropathy (MeN), formerly called chronic kidney disease of unknown cause (CKDu), refers to chronic kidney disease (CKD) that presents in young and middle-aged Central Americans in the absence of any clear etiology. MeN is a relatively new diagnosis with rapidly rising prevalence in specific regions of El Salvador and Nicaragua, Guatemala, and Costa Rica. It is seldom associated with hyperuricemia. We present a case of a patient with gouty arthritis and hyperuricemia with associated CKD due to MeN. We also provide a review of literature of this disease.

Dual antiplatelet agents and high-intensity statins are frequently used in combination after myocardial infarction. Ticagrelor has the potential of causing acute kidney injury. Rosuvastatin is excreted through the kidneys and dose adjustment is needed in patients with kidney disease. When used in combination, they can potentiate the toxic effects of each other. We report a case of drug interaction between rosuvastatin and ticagrelor resulting in rhabdomyolysis and acute renal failure necessitating dialysis. This case stresses the importance of monitoring renal function and adjusting the dose of rosuvastatin accordingly in patients with kidney disease.

Introduction: Anemia has been implicated in heart failure. Existing literatures, involving predominantly African-Americans, suggests that Sickle Cell Disease (SCD) maybe linked to various cardiovascular complications including pulmonary hypertension and left venticular dysfunction. Peculiarly, our study involves exclusively Sub-Saharan population. Method: We conducted a cross sectional observational study of 208 hydroxyurea-naive consecutive SCD patients aged 10-52 years at steady state and 94 healthy non-matched controls who were studied in an out patient clinic in Sub-Saharan Africa. SCD patients were required to have electrophoretic or liquid chromatography documentation of major sickling phenotypes. Control group was required to have non-sickling phenotypes. Cardiac measurements were performed with TransThoracic Echo according to American Society of Echocardiography guidelines. Hemoglobin level was also obtained. Results: Hemoglobin level in SCD group (8.5+/- 1.5) was significant (P Conclusions: We were unable to demonstrate existence of anemia-associated left ventricular dysfunction in Sub-Saharan African with SCD. Further studies is required to highlight the reason behind this finding.

Contrast-induced acute kidney injury (CI-AKI) is a common complication of many diagnostic and therapeutic cardiovascular procedures. It is associated with longer in-hospital stay, more complicated hospitalization course, and higher in-hospital morbidity and mortality. With increasing use of contrast media in various diagnostic and interventional procedures, the prevalence of CI-AKI is expected to rise. Although pre-hydration with intravenous normal saline is recommended in patients with elevated risk of CI-AKI, this approach is often not feasible in many clinical settings. Remote ischemic conditioning (RIC), elicited by application of one or more, brief, non-injurious episodes of ischemia and reperfusion of a limb, is a promising therapy for preventing or attenuating the deleterious effects of contrast media on the kidney. Although the mechanisms of protection by RIC have not been completely defined, complex humoral, neural, and inflammatory pathways have been hypothesized to be in play. Given that RIC is non-invasive and cheap, it is attractive from clinical and economic perspective as a therapy to protect the kidney from CI-AKI. In this succinct review, we highlight the unifying mechanisms of CI-AKI and provide an overview of proposed biological mechanisms of renal protection by RIC. Emerging pre-clinical and clinical evidence in interventional cardiology are also discussed.

Introduction There is some evidence concerning the role of testosterone in cardiovascular diseases including heart failure. Some evidence favors reduced risk of cardiovascular events with higher levels while others have found no association. Hypothesis We hypothesized that lower testosterone level is associated with a lower hospital stay and admission rates in those with heart failure. Methods We used the NHANES database to identify males with a reported diagnosis of heart failure. The outcomes were inpatient admission in the past year and the number of days spent in the hospital in the past year. Results We identified 284 males with a reported a diagnosis of heart failure in 2011-2016 NHANES, mean age was 66.5 years, and there was no statistically significant difference in age between the group with serum testosterone less than 250 ng/ml and the group with serum testosterone more than 250 ng/ml(p=0.21). In the monovariate analysis, the group with lower testosterone levels are less likely to be admitted when compared to the group with higher testosterone, but this association was not statistically significant (25.6% vs. 40.0%,P=0.05). After multivariate analysis using logistic regression adjusting for comorbid conditions, the odds of being admitted is less in those with normal testosterone, but this was not statistically significant (OR 0.54, 95CI 0.25-1.57,p=0.11). In the linear regression model, we didn't find any significant effect of serum testosterone in the overall number of days spent in the hospital. Conclusions There was no evidence of an association between testosterone and increased admission and also no evidence of an association between serum testosterone and the overall length of stay. Some studies have shown possible benefits of testosterone supplementation in heart failure, but our study revealed that there is likely no effect on the risk of admission or length of stay.

Chronic pain is a condition that affects many patients and is often the main focus of primary care visits instead of managing risk factors that increase mortality. A European meta-analysis has demonstrated increased mortality in patients with chronic pain, including cardiovascular death. In this

Heart failure (HF) and atrial fibrillation (AF) share several risk factors including coronary artery disease, hypertension, smoking, obesity, diabetes, and renal disease, as well as common pathophysiologic pathway involving activation of the renin-angiotensin-aldosterone system, maladaptive atrial

Heavy metals, defined as metals with densities higher than 5g/cm3, have the ability to interact with various physiological processes in the body with cardiovascular consequences. We sought to gain better understanding between the relationship of serum levels of heavy metals and serum total and LDL

There is paucity of data on outcomes of Human Immunodeficiency Virus (HIV) patients that are hospitalized and had percutaneous coronary intervention (PCI). Our study describes the characteristics and outcomes of HIV patients that were hospitalized and had PCI in the United States over a period of 16

The HEART score was designed to aid in disposition of patients presenting to the emergency department (ED) with chest pain (CP). Using prospectively collected data from the local and regional electronic health record systems, CP presentations to the ED of an academic institution were investigated.

Background: Various papers on sickle cell disease (SCD) in the USA reveals cardiac dysfunction. However, the highest burden of SCD is in Sub Saharan Africa. Amidst this population, use of hydroxyurea, blood transfusion and iron overload is extremely limited, allowing for a unique assessment of