Biomedical subjects

Kenneth J Mukamal

Publications and source records attributed to Kenneth J Mukamal.

41 records · Page 3Linked to original sources

PubMed2002

Tea consumption and mortality after acute myocardial infarction.

BACKGROUND: Some studies have suggested that tea consumption may be associated with lower mortality among individuals with cardiovascular disease, but the effects of tea consumption on mortality after acute myocardial infarction are unknown. METHODS AND RESULTS: As part of the Determinants of Myocardial Infarction Onset Study, we performed a prospective cohort study of 1900 patients hospitalized with a confirmed acute myocardial infarction between 1989 and 1994, with a median follow-up of 3.8 years. Trained interviewers assessed self-reported usual weekly caffeinated tea consumption during the year before infarction with a standardized questionnaire. We compared long-term mortality according to tea consumption using Cox proportional hazards regression. Of the 1900 patients, 1019 consumed no tea (nondrinkers), 615 consumed <14 cups per week (moderate tea drinkers), and 266 consumed 14 or more cups per week (heavy tea drinkers). Compared with nondrinkers, age- and sex-adjusted mortality was lower among moderate tea drinkers (hazard ratio, 0.69; 95% CI, 0.53 to 0.89) and heavy tea drinkers (hazard ratio, 0.61; 95% CI, 0.42 to 0.86). Additional adjustment for clinical and sociodemographic characteristics did not appreciably alter this association (hazard ratio, 0.72; 95% CI, 0.55 to 0.94 for moderate tea drinkers; hazard ratio, 0.56; 95% CI, 0.37 to 0.84 for heavy tea drinkers). The association of tea and mortality was similar for total and cardiovascular mortality. CONCLUSIONS: Self-reported tea consumption in the year before acute myocardial infarction is associated with lower mortality after infarction.

Cohort Studies↗

PubMed2002

Clinicians, educators, and investigators in general internal medicine: bridging the gaps.

Financial and time pressures, disparate promotional pathways, geographic separation, and difficulty acknowledging personal fallibility can contribute to polarization of clinician-educators and investigators in general internal medicine (GIM). As a consequence, clinician-educators and investigators may fail to use their joint expertise, may encounter friction in their relationships, and may present a troubled image to trainees considering careers in GIM. We suggest specific strategies that clinician-educators, investigators, administrative leaders, and medical schools might use to foster collaboration.

Academic Medical Centers↗

PubMedDate not supplied

Alcohol consumption and abnormalities of brain structure and vasculature.

Research on how alcohol consumption influences the structure and blood supply of the brain has generally focused on two primary areas of interest: the atrophic effect of heavy drinking on brain structure and the effects of moderate and heavy drinking on the risk of stroke. Heavy alcohol consumption results in atrophy of gray and white matter, particularly in the frontal lobes, cerebellum, and limbic structures. Heavy drinking also raises the risk of ischemic and hemorrhagic stroke, while light drinking is associated with a lower risk of ischemic stroke. Recently, the author and his colleagues studied alcohol consumption and prevalence of subclinical abnormalities detected by magnetic resonance imaging of the brain among 3376 older adults enrolled in the Cardiovascular Health Study. They found that alcohol consumption was positively associated with measures of brain atrophy and inversely associated with subclinical infarcts in a dose-dependent manner. Alcohol consumption and white matter lesions had a U-shaped relationship, with the lowest prevalence among those who consumed 1-6 drinks per week. Further research is needed to determine how these associations interact to influence overall brain function.

Aging↗

PubMedDate not supplied

Traditional and novel risk factors in older adults: cardiovascular risk assessment late in life.

As a population-based, longitudinal study of nearly 6000 older American adults, the Cardiovascular Health Study provides an excellent opportunity to assess the roles of traditional and novel cardiovascular risk factors in the development of coronary heart disease. Cardiovascular Health Study investigators have analyzed both traditional risk factors, such as diabetes, hypertension, and smoking, and new risk factors, such as hemostatic factors, inflammatory markers, exposure to infectious agents, and genetic determinants. These analyses have led to several important conclusions. First, older adults without previous cardiovascular events have a tremendous burden of subclinical vascular disease, which may change how physicians view risk factor modification in this age group. Second, some traditional cardiovascular risk factors lose importance as predictors of cardiovascular disease among older adults. Third, even modest elevations in fasting blood glucose or systolic blood pressure-below the levels used to define diabetes or hypertension-may have prognostic implications. Fourth, novel cardiovascular risk factors may add further information about cardiovascular disease risk in older adults. Promising potential candidates identified in the Cardiovascular Health Study include markers of hemostatic activation, fibrinogen, factor VIII coagulant activity, C-reactive protein, and exposure to herpes simplex virus-1 and possibly chlamydia. Future Cardiovascular Health Study investigations will help to clarify which combination of traditional and newer risk factors provides the best estimate of cardiovascular risk for older adults.

Aged↗

PubMedDate not supplied

Restocking the sample closet: results of a trial to alter medication prescribing.

BACKGROUND: Although medication costs make up a large and growing portion of health care costs, few interventions have successfully encouraged physicians to alter prescribing patterns. METHODS: To promote the use of an open formulary, we altered the contents of the sample closets of five primary care practices in eastern Massachusetts. In these practices, we removed all nonformulary drugs in five drug classes and restocked with purchased generic samples. We performed a time series analysis of formulary compliance, before and during an 8-month intervention, with five concurrent control practices for comparison. RESULTS: Although providers in both the intervention and control practices complied well with the formulary, we found no incremental effect of the sample closet intervention on absolute formulary compliance (P = .46) or on the secular trend in formulary compliance (P = .60). We also found no effect on these measures in any of the individual drug classes studied. CONCLUSIONS: This sample closet intervention did not appear to improve further the good formulary compliance in these practices. In such settings, better ways are needed to guide prescribing behavior.

Boston↗