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Biomedical subjects

Lori Mosca

Publications and source records attributed to Lori Mosca.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of quality of life among women with coronary heart disease.

BACKGROUND: Health-related quality of life (HRQOL) is an increasingly relevant outcome as the population ages and associated morbidities increase. The purpose of this study was to evaluate predictors of HRQOL among ethnically diverse women hospitalized for coronary heart disease (CHD) and determine the impact of a brief, educational intervention on HRQOL 6 months post-hospitalization. METHODS: Women (n = 160; mean age 63 years, 53% minority) admitted for CHD at three academic hospitals who completed a 6 month secondary prevention trial were studied. The SF-36 was administered at admission and 6 months. Multiple linear regressions were used to identify significant independent predictors of 6 month HRQOL. RESULTS: Significant improvements in HRQOL were noted from admission to 6 months post-hospitalization. Subjects reporting better HRQOL at 6 months included those who were employed, married, physically active, enrolled in cardiac rehabilitation, and not depressed. Women who received an educational intervention had significantly less bodily pain at 6 months compared with usual care in a model adjusted for baseline HRQOL and physical activity goal adherence (p = 0.04). CONCLUSIONS: Baseline HRQOL (8 SF-36 subscales), physical activity (3 SF-36 subscales) and marital status (1 SF-36 subscale) were the major determinants of HRQOL at 6 months post-hospitalization. Future interventions and preventive efforts should be targeted to women with CHD who have impaired HRQOL and may be at increased risk of poor clinical outcomes.

Academic Medical Centers↗
PubMed2006

Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.

BACKGROUND: The effect of raloxifene, a selective estrogen-receptor modulator, on coronary heart disease (CHD) and breast cancer is not established. METHODS: We randomly assigned 10,101 postmenopausal women (mean age, 67.5 years) with CHD or multiple risk factors for CHD to 60 mg of raloxifene daily or placebo and followed them for a median of 5.6 years. The two primary outcomes were coronary events (i.e., death from coronary causes, myocardial infarction, or hospitalization for an acute coronary syndrome) and invasive breast cancer. RESULTS: As compared with placebo, raloxifene had no significant effect on the risk of primary coronary events (533 vs. 553 events; hazard ratio, 0.95; 95 percent confidence interval, 0.84 to 1.07), and it reduced the risk of invasive breast cancer (40 vs. 70 events; hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.83; absolute risk reduction, 1.2 invasive breast cancers per 1000 women treated for one year); the benefit was primarily due to a reduced risk of estrogen-receptor-positive invasive breast cancers. There was no significant difference in the rates of death from any cause or total stroke according to group assignment, but raloxifene was associated with an increased risk of fatal stroke (59 vs. 39 events; hazard ratio, 1.49; 95 percent confidence interval, 1.00 to 2.24; absolute risk increase, 0.7 per 1000 woman-years) and venous thromboembolism (103 vs. 71 events; hazard ratio, 1.44; 95 percent confidence interval, 1.06 to 1.95; absolute risk increase, 1.2 per 1000 woman-years). Raloxifene reduced the risk of clinical vertebral fractures (64 vs. 97 events; hazard ratio, 0.65; 95 percent confidence interval, 0.47 to 0.89; absolute risk reduction, 1.3 per 1000). CONCLUSIONS: Raloxifene did not significantly affect the risk of CHD. The benefits of raloxifene in reducing the risks of invasive breast cancer and vertebral fracture should be weighed against the increased risks of venous thromboembolism and fatal stroke. (ClinicalTrials.gov number, NCT00190593 [ClinicalTrials.gov].).

Aged↗
PubMed2006

National study of women's awareness, preventive action, and barriers to cardiovascular health.

BACKGROUND: There is growing awareness of cardiovascular disease (CVD) as the leading cause of death in women, but whether this greater awareness is associated with increased action by women to lower their personal or family's risk is unknown. METHODS AND RESULTS: A nationally representative sample of 1008 women selected through random-digit dialing were given a standardized questionnaire about history of CVD/risk factors, awareness of leading cause of death, knowledge of healthy and personal levels of CVD risk factors, self-reported actions taken to reduce risk, and barriers to heart health. The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 (55% versus 30%) was significantly greater for whites compared with blacks and Hispanics (62% versus 38% and 34%, respectively) and was independently correlated with increased physical activity (odds ratio, 1.35; 95% CI, 1.00 to 1.83) and weight loss (odds ratio, 1.47; 95% CI, 1.14 to 2.02) in the previous year in logistic regression models. Fewer than half of the respondents were aware of healthy levels of risk factors. Awareness that personal level was not healthy was positively associated with action. Most women took steps to lower risk in family members and themselves. The most frequently cited barriers for heart health were confusion in the media (49%), the belief that health is determined by a higher power (44%), and caretaking responsibilities (36%). CONCLUSIONS: General awareness of CVD risk among women is associated with preventive action. Educational interventions need to be targeted at racial/ethnic minority women.

Adult↗
PubMed2006

The relation of blood pressure to coronary heart mortality in different age groups varies by ethnicity.

BACKGROUND: The relative importance of pulse pressure, mean arterial pressure, systolic blood pressure (SBP), and diastolic blood pressure (DBP) as predictors of coronary heart disease (CHD) have been shown to change with aging in individuals of white ethnicity, but few published data exist for those of African American ethnicity. METHODS: To assess the role of ethnicity in this relationship we compared the association of BP indices to CHD mortality (from a pooled database of eight prospective cohorts, n = 29829, follow-up 13.8 +/- 7.9 years, 1912 events) in the four age groups (30 to 39, 40 to 49, 50 to 59, and > or = 60 years) by the decrease in the -2 log likelihood in Cox regression analyses of subjects who were not receiving antihypertensive drug therapy at baseline. RESULTS: All BP indices were significant (P < .05) for all age groups in models containing a single BP index. In white subjects, the best predictor of CHD mortality was DBP for persons 30 to 39 years of age, whereas SBP was the best predictor for persons 40 to 49, 50 to 59 and > or = 60 years of age. In African American subjects, SBP was the best predictor in all age groups. When considered jointly, DBP, but not SBP, was significantly associated with CHD mortality in white subjects 30 to 39 years of age. Only SBP was significant in white subjects 40 to 49, 50 to 59, and > or = 60 years of age. In African Americans, SBP, but not DBP, was associated with CHD mortality in all four age groups when both were in the model. CONCLUSION: In African American subjects, SBP was found to be a better predictor of CHD mortality than DBP or pulse pressure. In white subjects, there was a shift in importance from DBP to SBP as predictors of CHD mortality from the 30 to 39-year age group to the older groups.

Adult↗
PubMed2006

Ethnic differences in barriers and referral to cardiac rehabilitation among women hospitalized with coronary heart disease.

Important gender differences in cardiac rehabilitation utilization are well established, yet few studies have documented whether reported barriers and referrals vary by ethnicity. This is a cross-sectional study to determine whether barriers and referrals to participation in cardiac rehabilitation differed by race/ethnicity in 304 women (52% ethnic minorities) hospitalized with coronary heart disease. Nearly all subjects (92%) strongly agreed that physician referral was important to participation in rehab, but only 22% of subjects reported physician instruction to attend. Whites were more likely than minorities to report instruction to attend cardiac rehabilitation, and minorities were more likely to report financial barriers when compared with whites. These disparities need to be addressed because minority women have a worse prognosis following hospitalization for coronary heart disease, and cardiac rehabilitation has been shown to improve survival.

Aged↗
PubMed2006

Quality of cardiovascular disease preventive care and physician/practice characteristics.

BACKGROUND: Quality of cardiovascular disease (CVD) preventive care is suboptimal. Recent data correlated increasing years in practice for physicians with lower-quality health care. OBJECTIVE: The purpose of this study was to assess physician awareness/adherence to national blood pressure, cholesterol, and CVD prevention guidelines for women according to physician/practice characteristics. DESIGN: Standardized online survey and experimental case studies were administered to 500 randomly selected U.S. physicians. Multivariable regression models tested physician age, gender, specialty, and practice type as independent predictors of guideline awareness/adherence. RESULTS: Compared with older physicians (50+ years), younger physicians (<50 years) reported a lower level of awareness of cholesterol guidelines (P=.04) and lower incorporation of women's guidelines (P=.02). Yet, older physicians were less likely to recommend weight management for high-risk cases (P=.03) and less confident in helping patients manage weight (P=.045) than younger physicians. Older physicians were also less likely to identify a low-density lipoprotein<100 mg/dL as optimal versus younger physicians (P=.01), as were solo versus nonsolo practitioners (P=.02). Solo practitioners were less aware of cholesterol guidelines (P=.04) and were more likely to prescribe aspirin for low-risk female patients than nonsolo practitioners (P<.01). Solo practitioners rated their clinical judgment as more effective than guidelines in improving patient health outcomes (P<.01) and more frequently rated the patient as the greatest barrier to CVD prevention versus nonsolo practitioners (P<.01). CONCLUSIONS: Though guideline awareness is high, efforts to promote their utilization are needed and may improve quality outcomes. Targeted education and support for CVD prevention may be helpful to older and solo physicians.

Adult↗
PubMed2005

Usefulness of arterial compliance in the thigh in predicting exercise capacity in individuals without coronary heart disease.

This study examined the relation between arterial compliance of the lower extremities and aerobic capacity in patients with a broad spectrum of cardiovascular risk but without overt coronary heart disease (CHD). Local arterial compliance was noninvasively measured in the thigh and calf in 104 men and 99 women using air plethysmography. Subjects also underwent maximal exercise treadmill testing as a measure of aerobic capacity. In univariate analysis, age (r = -0.49, p <0.001), systolic blood pressure at rest (r = -0.27, p <0.001), pulse pressure (r = -0.39, p <0.001), total cholesterol (r = -0.25, p <0.001), triglycerides (r = -0.025, p <0.001), non-high-density lipoprotein cholesterol (r = -0.23, p <0.001), high-sensitivity C-reactive protein (r = -0.21, p = 0.002), and low-density lipoprotein cholesterol (r = -0.15, p = 0.03) all demonstrated a significant inverse association with treadmill time. Thigh and calf compliance demonstrated a significant positive association with treadmill time (r = 0.48, p <0.001; r = 0.46, p <0.001). In multivariate analysis, thigh compliance (p = 0.003), age (p <0.001), gender (p = 0.005), and triglycerides (p = 0.017) were independent predictors of treadmill time. In conclusion, thigh compliance measured with a simple-to-use, fully automated device independently predicts aerobic fitness in patients with a wide range of cardiovascular risk but without CHD.

Arteries↗
PubMed2005

Association of blood pressure indices and stroke mortality in isolated systolic hypertension.

BACKGROUND AND PURPOSE: Isolated systolic hypertension (ISH), systolic blood pressure (BP) > or =160 mm Hg and diastolic BP (DBP) <90 mm Hg, is associated with stroke; however, the correlation between specific BP indices and stroke mortality in ISH is not defined. METHODS: In a pooled analysis of 9 epidemiological studies, we examined whether pulse pressure (PP) was more predictive of stroke mortality than systolic BP (SBP), DBP, or mean BP (MAP) in persons with ISH. Subjects (n=682; 29% male; 77% white; mean age 63.6 years) with ISH, free of cardiovascular disease, and not on antihypertensive drug therapy at baseline were followed a mean of 13.0+/-7.3 years, and 54 stroke deaths occurred. The relative importance of each BP index was compared by the decrease in the -2 log likelihood (a measure of model agreement with data) because of the addition of 1 or a combination of BP indices to a Cox regression model. Hazards ratios (HRs) for fatal stroke for a 1-SD in BP index were determined. RESULTS: PP was the best predictor of stroke mortality based on the decrease in the -2 log likelihood (10.65; P=0.001; HR=1.52), followed by SBP (7.19; P=0.007; HR=1.40), DBP (2.76; P=0.10; HR=0.80), or MAP (0.39; P=0.39; HR=1.10). Any combination of BP indices did not exceed a decrease in the -2 log likelihood of 10.72. CONCLUSIONS: These data suggest that in persons with ISH, PP is a better predictor of fatal stroke than SBP, DBP, or MAP.

Aged↗
PubMed2005

Comparison of the relation of triglyceride-rich lipoproteins and muscular artery compliance in healthy women versus healthy men.

To determine whether structural features or concentrations of plasma lipoproteins are predictive of arterial compliance in healthy women versus healthy men, cohorts of 111 men and 112 women with a wide range of 10-year risks for coronary artery disease were selected using assessments based on the Framingham Heart Study. Age ranges were restricted to 35 to 69 years for men and 45 to 79 years for women. Lipid-lowering drugs or any evidence of vascular disease was cause for exclusion. Fasting lipoprotein analysis and arterial compliance measurements in thigh and calf were completed in all patients. Plasma triglyceride levels were the most powerful predictor of compliance in women. Weaker but significant relations were observed between plasma non-high-density lipoprotein cholesterol, apolipoprotein-B, and apolipoprotein-CIII. In contrast, the only significant predictor of compliance in men was body weight. Thus, the major lipid predictors of arterial stiffness in women are concentrations of triglyceride-rich lipoproteins. These results are consistent with previous findings that triglyceride measurements are more strongly related to clinical vascular events in women than in men.

Adult↗
PubMed2005

American Heart Association and American Stroke Association national survey of stroke risk awareness among women.

BACKGROUND: Stroke is the third leading cause of death in the United States and a major cause of morbidity in women. Awareness of risk may be an important first step in stroke prevention. The purpose of this study was to assess knowledge and awareness about stroke in a nationally representative sample of women. METHODS AND RESULTS: An American Heart Association-sponsored telephone survey using random-digit dialing was conducted in June and July of 2003. Respondents were 1024 women > or =25 years of age, including an oversampling of racial/ethnic minorities (68% white, 12% black, 12% Hispanic). Participants were given a standardized questionnaire about heart disease and stroke risk. Only 26% of women > or =65 years of age reported being well informed about stroke, even though this group carries the highest incidence of stroke. Overall, 20% of women stated that they worried a lot about stroke. Among women aged 25 to 34 years, 37% stated that they were not at all informed about stroke, which was significantly higher than for women between 45 and 64 years (13%, P<0.05) and those > or =65 years of age (14%, P<0.05). More Hispanics reported being not at all informed about stroke compared with whites (32% versus 19%, P<0.05) and blacks (32% versus 20%, P<0.05). More white women were aware that at the onset of a stroke, treatment could be given to break up blood clots compared with blacks (92% versus 84%, P<0.05) and Hispanics (92% versus 79%, P<0.05). Correct identification of the warning signs of stroke was low among all racial/ethnic and age groups. More white respondents correctly identified sudden 1-sided weakness or numbness of the face or a limb as a warning sign compared with Hispanics (39% versus 29%, P<0.05). Whites identified difficulty talking or understanding speech as a sign of stroke significantly more often than did Hispanics (29% versus 17%, P<0.05). CONCLUSIONS: Results of this national survey document that awareness and knowledge about stroke is suboptimal among women, especially among racial/ethnic minorities, who are at highest risk. These data support the need for targeted educational programs about stroke risk and symptoms and underscore the importance of public health programs to improve awareness of stroke among women.

Adult↗
PubMed2005

Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting.

BACKGROUND: The American Heart Association (AHA) recently established evidence-based recommendations for cardiovascular disease (CVD) prevention in women, including lipid management. This study evaluated optimal lipid-level attainment and treatment patterns on the basis of these guidelines in high-risk women in a managed care setting. METHODS AND RESULTS: We conducted a historical prospective cohort analysis of a 1.1-million-member, integrated, managed-care database. Eligible high-risk women were those with evidence of previous CVD or risk equivalent who had a full lipid panel available between October 1, 1999, and September 30, 2000; were naive to lipid therapy; and had a minimum of 12 months health plan eligibility preindex and postindex lipid panel. Optimal lipid levels were defined as LDL cholesterol (LDL-C) <100 mg/dL, HDL cholesterol (HDL-C) >50 mg/dL, non-HDL-C <130 mg/dL, and triglycerides <150 mg/dL. Laboratory values and lipid pharmacotherapy were assessed longitudinally over the postindex follow-up (up to 36 months). A total of 8353 high-risk women (mean age, 66+/-14 years) with a mean follow-up of 27+/-8 months were included. Only 7% attained optimal combined lipid levels initially, and this increased to 12% after 36 months. Lipid-modifying therapy was initiated in 32% of patients, including 35% of women with LDL-C > or =100 mg/dL and 15% with LDL-C <100 mg/dL. CONCLUSIONS: Among high-risk women, few attained the AHA's standards for all lipid fractions, and only one third received recommended drug therapy, highlighting significant opportunities to apply evidence-based recommendations to manage lipid abnormalities in high-risk women.

Adult↗
PubMed2005

National study of physician awareness and adherence to cardiovascular disease prevention guidelines.

BACKGROUND: Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender. METHODS AND RESULTS: An online study of 500 randomly selected physicians (300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles (P<0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin (P<0.01) and more weight management recommended (P<0.04) for intermediate-risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD. CONCLUSIONS: Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.

Attitude of Health Personnel↗
PubMed2005

Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association.

Cardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with >240,000 women dying annually from the disease. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus statement. Research continues to report underrecognition and underdiagnosis of CAD as contributory to high mortality rates in women. Timely and accurate diagnosis can significantly reduce CAD mortality for women; indeed, once the diagnosis is made, it does appear that current treatments are equally effective at reducing risk in both women and men. As such, noninvasive diagnostic and prognostic testing offers the potential to identify women at increased CAD risk as the basis for instituting preventive and therapeutic interventions. Nevertheless, the recent evidence-based practice program report from the Agency for Healthcare Research and Quality noted the paucity of women enrolled in diagnostic research studies. Consequently, much of the evidence supporting contemporary recommendations for noninvasive diagnostic studies in women is extrapolated from studies conducted predominantly in cohorts of middle-aged men. The majority of diagnostic and prognostic evidence in cardiac imaging in women and men has been derived from observational registries and referral populations that are affected by selection and other biases. Thus, a better understanding of the potential impact of sex differences on noninvasive cardiac testing in women may greatly improve clinical decision making. This consensus statement provides a synopsis of available evidence on the role of the exercise ECG and cardiac imaging modalities, both those in common use as well as developing technologies that may add clinical value to the diagnosis and risk assessment of the symptomatic and asymptomatic woman with suspected CAD.

Coronary Artery Disease↗
PubMed2005

Weight changes and obesity predict impaired resting and endothelium-dependent myocardial blood flow in postmenopausal women.

BACKGROUND: Obesity has been associated with impaired endothelial function, but the influence of lifetime weight patterns on endothelial function has not been studied. HYPOTHESIS: We hypothesized that coronary vascular reactivity would be diminished in postmenopausal women with a history of obesity and frequent weight swings. METHODS: We performed dynamic N-13 ammonia positron emission tomography in 18 postmenopausal women with cardiac risk factors. Myocardial blood flow (MBF) was measured at rest, after the cold pressor test (CPT), and after adenosine infusion in order to determine baseline and endothelium-dependent and -independent flows, respectively. Myocardial blood flow was corrected for cardiac work by normalizing to the rate-pressure product. Weight history was obtained by standardized questionnaire. RESULTS: Normalized rest (n-rest) MBF correlated negatively with current weight (r = -0.52, p = 0.026) and weight at age 18 (r = -0.47, p = 0.047). Normalized CPT (n-CPT) MBF correlated inversely with current weight (r = -0.55, p = 0.018), weight at age 18 (r = -0.605, p = 0.008), and highest weight (r = -0.62, p = 0.006). Higher waist circumference predicted lower n-rest MBF (r = -0.52, p = 0.028) and n-CPT MBF (r = -0.48, p = 0.04). The same association was found with hip circumference (r = -0.52, p = 0.028; r = -0.49, p = 0.038, respectively), whereas higher body mass index (BMI) predicted lower n-CPT MBF (r = -0.53, p = 0.02). Women with at least four significant weight swings had lower MBF during rest, CPT, and n-CPT (0.88 vs. 1.19 ml/g/min, p = 0.008; 0.76 vs. 1.23 ml/g/min, p < 0.001; 0.74 vs. 1.10 ml/g/min, p = 0.009, respectively). CONCLUSIONS: Increased waist and hip circumference, weight, and frequent weight swings are associated with impaired resting and endothelium-dependent MBF in postmenopausal women. These data suggest that lifetime weight patterns may influence cardiovascular risk in women.

Aged↗
PubMed2005

Prevalence of breast arterial calcifications in an ethnically diverse population of women.

PURPOSE: Breast arterial calcifications (BAC) identified on routine mammography have been associated with coronary heart disease (CHD) risk factors including diabetes and hypertension, angiographically defined CHD, and increased cardiovascular mortality. Accumulating evidence suggests that the mammogram may be an important tool to identify women at risk for CHD, however, the epidemiology of BAC has been poorly defined and previous studies limited to white populations. METHODS: The mammograms of 1905 consecutive women (51.2% Hispanic, 25.8% white, 15.3% black, 5.4% other, 2.2% Asian, ages 35-92 years) were evaluated for the presence of BAC and the number of calcified arteries. RESULTS: The overall prevalence of BAC was 29.4% and was significantly higher for Hispanics compared with whites (34.5% vs. 24.0%, p=0.0002) and lower for Asians compared with whites (7.1% vs. 24.0%, p < 0.02). Among BAC-positive women aged 65 years or less, blacks had more calcified arteries than whites (p < 0.01). The presence of BAC increased with age (p for trend < 0.0001). In age-adjusted models, older Hispanics were more likely to be BAC-positive than whites of similar age (p < 0.02). CONCLUSION: These results indicate that BAC varies significantly by age and race/ethnicity. These findings should be taken into consideration when designing future studies of BAC and CHD.

Adult↗