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Lori Mosca

Publications and source records attributed to Lori Mosca.

At least 37 records · Page 2Linked to original sources
PubMed2005

The gender gap in coronary heart disease mortality: is there a difference between blacks and whites?

BACKGROUND: The gender difference (gender gap) in mortality due to coronary heart disease (CHD) decreases with age. This relationship has not been well characterized in diverse populations. METHODS: To examine the gender gap in CHD mortality across age groups and to compare the age dependency of the gender gap between blacks and whites, we conducted a prospective cohort study combining data from 9 U.S. epidemiological studies (Atherosclerosis Risk in Communities Study [ARIC], Charleston Heart Study, Evans County Study, Framingham Heart Study [original and offspring cohorts], National Health Examination Follow-up Study [NHEFS], Rancho Bernardo Study, San Antonio Heart Study, and Tecumseh Community Health Study). Baseline examinations were performed between 1958 and 1990 (depending on the study), and mean follow-up was 13.7 years in general communities in several U.S. geographic areas. We included 39,614 subjects >30 years and free of cardiovascular disease (CVD) at baseline (18% blacks, 37% men). Completion of follow-up was >97% for all studies. As the main outcome measures, age-specific CHD mortality rates and male/female CHD mortality hazard ratios were calculated using Cox hazards regression. RESULTS: During 542,605 person-years of follow-up, 2,812 CHD deaths were observed (18% in blacks, 46% in men). At age 45, white men were at a 6-fold increased risk compared with white women (95% confidence interval [95% CI] 4.6-7.9), whereas black men had a 2-fold increased risk of fatal CHD compared with black women (1.4-3.6). At age 95, men and women were at equal risk in both whites (0.9-1.4) and blacks (0.7-1.6). The difference in the age dependency of the gender gap between blacks and whites was significant (p < 0.0001). CONCLUSIONS: The gender difference in CHD mortality was more pronounced in whites than in blacks at younger ages. This discrepancy was not explained by adjustment for CHD risk factors and suggests that other factors may be responsible for the ethnic variation in the gender gap.

Adult↗
PubMed2005

Management of dyslipidemia in women in the post-hormone therapy era.

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death for women in the United States and is largely preventable. The American Heart Association has recently released evidence-based guidelines for the prevention of CVD in women; these include gender-specific recommendations for the management of dyslipidemia. This article reviews these recommendations and the evidence supporting them. DESIGN: This was a qualitative review of a systematic literature search related to lipid guidelines for women and discussion of rationale and evidence for new clinical recommendations. MAIN RESULTS: Lifestyle modifications are the cornerstone of lipid management. Substantial evidence from randomized clinical trials supports the use of low-density lipoprotein cholesterol-lowering therapy (primarily statins) in all high-risk women and the use of niacin or fibrates when high-density lipoprotein cholesterol is low or non-high-density lipoprotein cholesterol is elevated. Fewer data are available for women at lower or intermediate risk. CONCLUSIONS: Encouragement of lifestyle modification and appropriate use of lipid-altering therapy will have a substantial impact on reducing the burden of cardiovascular disease in women.

Anticholesteremic Agents↗
PubMed2004

Relationship between arterial stiffness and subclinical aortic atherosclerosis.

BACKGROUND: Noninvasive measures of arterial compliance may be useful for the detection of subclinical atherosclerosis. METHODS AND RESULTS: Measures of calf and thigh arterial compliance (MaxV50) were recorded in 267 subjects who also underwent MRI of the distal aorta to quantify distal aorta atherosclerosis. The average of calf and thigh MaxV50 was strongly predictive of extent of aortic atherosclerosis and risk of being in the top quartile of aortic atherosclerosis after adjustment for the Framingham Coronary Risk Score (FCRS) or the combination of the FCRS and C-reactive protein (P<0.0001). The areas under the receiver operating curves predicting the top quartile of gender-specific aortic atherosclerosis were 0.57, 0.60, and 0.75 for models containing the FCRS, the FCRS and C-reactive protein, and the FCRS, C-reactive protein, and the average of calf and thigh MaxV50. CONCLUSIONS: Lower-extremity arterial compliance may identify subjects with extensive subclinical atherosclerosis. Further studies examining the potential value of arterial stiffness as a screening tool to guide initiation of more aggressive preventive interventions are warranted.

Adult↗
PubMed2004

Tracking women's awareness of heart disease: an American Heart Association national study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in men and women in the United States, yet prior research has shown a lack of awareness of risk among women. The purpose of this study was to assess the contemporary awareness, knowledge, and perceptions related to CVD risk among American women and to evaluate trends since 1997, when the American Heart Association initiated a national campaign to improve awareness of CVD among women. METHODS AND RESULTS: A telephone survey of a nationally representative random sample of women was conducted in June and July 2003, with an oversampling of black and Hispanic women; results were compared with those of similar surveys in 2000 and 1997. The present survey included 1024 respondents age > or =25 years; 68% were white, 12% black, 12% Hispanic, and 8% other ethnicities. Awareness, knowledge, and perceptions about heart disease were evaluated by use of a standard interviewer-assisted questionnaire. A shift in awareness of heart disease as the leading killer of women has occurred since 1997. In 2003, 46% of respondents spontaneously identified heart disease as the leading cause of death in women, up from 30% in 1997 (P<0.05) and 34% in 2000 (P<0.05). In contrast, the percentage of women citing cancer as leading cause of death has significantly decreased. Black, Hispanic, and younger women (<45 years old) had lower awareness of heart disease as their leading cause of death than did white and older women. Nearly all women reported comfort in discussing prevention with healthcare providers, but only 38% of women reported that their doctors had ever discussed heart disease with them. CONCLUSIONS: Awareness of CVD has increased, although a significant gap between perceived and actual risk of CVD remains. Educational interventions to improve awareness and knowledge are needed, particularly for minority and younger women.

Adult↗
PubMed2003

Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women's Pooling Project.

BACKGROUND AND PURPOSE: Diabetes mellitus is an independent risk factor for stroke and is associated with a 1.8- to approximately 6-fold increased risk compared with nondiabetic subjects. Recent guidelines have classified diabetes as a coronary heart disease risk equivalent. Whether diabetes is a cardiovascular disease risk equivalent for stroke is not established. METHODS: Data were pooled from 9 prospective epidemiological studies in the United States. We followed up 27,269 women (8.5% diabetic, 2.9% with prior myocardial infarction, 2.3% with prior stroke) for an average of 8.3 years, during which 238 stroke deaths were observed. RESULTS: Both diabetic subjects without cardiovascular disease and nondiabetic subjects with history of prior stroke had a significantly increased risk of 10-year stroke mortality compared with nondiabetic subjects without prior cardiovascular disease (hazard ratio [HR], 6.77; 95% confidence interval [CI], 4.56 to 10.05; HR, 3.37; 95% CI, 2.38 to 4.77). History of prior myocardial infarction was not associated with long-term stroke mortality (HR, 0.66; 95% CI, 0.27 to 1.61). After adjustment for risk factors, diabetic subjects had similar risk compared with subjects with a history of prior stroke (HR, 1.29; P=0.43). CONCLUSIONS: Diabetic subjects without cardiovascular disease have a fatal stroke risk similar to that of nondiabetic subjects with a history of prior stroke and similar risk factor profile. This suggests that diabetes mellitus may be classified as a stroke risk equivalent and may warrant more aggressive treatment strategies in the future prevention of stroke.

Age Factors↗
PubMed2003

Contemporary awareness and understanding of cholesterol as a risk factor: results of an American Heart Association national survey.

BACKGROUND: Public awareness and understanding of risk factors for atherosclerotic vascular disease are essential for successful primary and secondary prevention. The American Heart Association is committed to reducing cardiovascular disease. METHODS: A professional market survey company conducted a structured national telephone survey of English-speaking adults 40 years and older on behalf of the American Heart Association. Regional and sex quotas were imposed on the sample, and responses were weighted to match the 1999 census projections for region of the country, age, sex, and race. RESULTS: Interviews were completed with 1163 adults 40 years and older. A national probability sample of 1114 was created. Of the final sample, 28.5% were 65 years or older, 56.1% were women, and 86.5% were white. Although 91.2% of respondents stated that it was "important to them personally to have a healthy cholesterol level" (77.6% extremely or very important), 51% did not know their own level. Only 40.2% were aware of national guidelines for cholesterol management, and 53.1% either did not know or overestimated the correct desirable total cholesterol level for a healthy adult. When asked what sources of information they rely on the most, 66.8% identified physicians, while only 3.7% rely primarily on the Internet. CONCLUSIONS: Public understanding of cholesterol management is suboptimal. Physicians have a unique opportunity, on the basis of public attitudes and access, to improve cholesterol education.

Adult↗
PubMed2003

Psychosocial factors predict coronary heart disease, but what predicts psychosocial risk in women.

OBJECTIVES: Psychosocial factors, including depression, anger, and social isolation, have been associated with increased morbidity and mortality from coronary heart disease (CHD), but predictors of psychosocial burden among women with CHD are poorly defined. The purpose of this study was to determine whether readily measured demographic and risk factors could identify women with psychosocial risk factors that are more difficult to assess in a clinical setting. METHODS: Baseline data on 304 women (mean age 62 years, 52% minority) hospitalized with CHD at 3 academic medical centers participating in a clinical study of adherence to prevention guidelines were evaluated. Standardized questionnaires were used to measure depression (4-item self-report tool from the Primary Care Evaluation of Mental Disorders questionnaire) and anger (Spielberger Trait Anger Scale). One self-report question was used to assess social isolation. RESULTS: Thirty-seven percent of women with CHD reported depression, 50% reported anger, and 41% reported social isolation. In a logistical model controlling for confounders, independent predictors of depression were having dependents (odds ratio [OR] = 2.27, p = .006), age (< or = 65 years) (OR = 1.91, p = .02), and exercise (< 3 days/week) (OR = 3.92, p < .001). Anger was associated with having dependents (OR = 3.16, p < .001), age (< or = 65 years) (OR = 1.95, p = .02), and smoking (OR = 2.05, p = .04). Subjects who had dependents (OR = 2.24, p = .005), were unemployed (OR = 1.93, p = .03), and who did not get enough exercise (< 3 days/week) (OR = 2.07, p = .03) reported higher isolation in adjusted models. Differences in prevalence of psychosocial factors by ethnicity were not statistically significant. However, there was a trend toward increased prevalence of psychosocial risk factors among white women, possibly reflecting the need for more culturally sensitive screening tools. CONCLUSION: These data may be helpful in identifying women who are at risk of increased CHD morbidity and mortality because of psychosocial burden.

Adult↗
PubMed2002

Baseline characteristics of participants in the Raloxifene Use for The Heart (RUTH) trial.

The Raloxifene Use for The Heart (RUTH) trial is a randomized, placebo-controlled, double-blind trial designed to determine whether raloxifene 60 mg/day compared with placebo lowers the risk of coronary events (coronary death, nonfatal myocardial infarction [MI], or hospitalized acute coronary syndromes other than MI) and reduces the risk of invasive breast cancer in women at risk for a major coronary event. Raloxifene is a selective estrogen receptor modulator that improves cardiovascular risk factors, reduces the risk of vertebral fracture, and is associated with a reduced incidence of invasive breast cancer in postmenopausal women with osteoporosis. Between June 1998 and August 2000, 10,101 women were enrolled at 187 sites in 26 countries. Approximately half of the women had documented coronary heart disease (CHD) (n = 5,031); the remainder had multiple CHD risk factors that increased their risk for a CHD event (n = 5,070). The mean age of participants was 68 years (39% were >70 years old), and did not differ between those with documented CHD and those at increased CHD risk. Most women were Caucasian (84%); 60% had a body mass index >/=27 kg/m(2), 46% had diabetes mellitus, 78% had systemic hypertension, and 14% had low-density lipoprotein cholesterol >160 mg/dl. Compared with women at increased CHD risk, women with documented CHD had higher cardiovascular risk scores, a higher prevalence of abnormal electrocardiograms, greater use of cardiovascular medications, were more likely to have had cardiac rehabilitation, and were more likely to have previously used estrogen or oral contraceptives, but had a slightly lower prevalence of CHD risk factors such as smoking, obesity, diabetes mellitus, and systemic hypertension, and had lower serum levels of total and low-density lipoprotein cholesterol. The RUTH cohort is the largest group of postmenopausal women at increased risk of CHD events ever assembled in a clinical trial, and is the first trial designed to determine the effect of a selective estrogen receptor modulator on the risk of CHD events.

Aged↗