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Michael H Alderman

Publications and source records attributed to Michael H Alderman.

At least 19 recordsLinked to original sources
PubMed2004

Glucose-cholesterol interaction magnifies coronary heart disease risk for hypertensive patients.

Elevated cholesterol and glucose are known independent risk factors for coronary heart disease. This study examines whether an adverse synergistic interaction of cholesterol and glucose magnifies coronary heart disease risk among treated hypertensive patients. Subjects were hypertensive patients (n=6672) in a worksite treatment program, with entry fasting glucose <6.99 mmol/L (126 mg/dL) and total cholesterol <6.72 mmol/L (260 mg/dL) observed for mean 5.6+/-4.5 years follow-up (range 0.5 to 21.7 years). Outcome events were incident hospitalization or death due to coronary heart disease. Cox proportional hazard models were constructed for the whole sample to assess interaction and then stratified by fasting glucose categories with thresholds defined either at impaired fasting glucose (> or =6.11 mmol/L [110 mg/dL]) or upper quartile (> or =5.72 mmol/L [103 mg/dL]). An interaction product term of total cholesterol and fasting glucose as continuous variables significantly (P=0.009) improved a Cox proportional hazards model, adjusting for total cholesterol, fasting glucose, and other coronary heart disease risk factors. Adjusted hazard ratios for 3 upper total cholesterol categories (with total cholesterol <5.17 mmol/L [200 mg/dL] as reference) in the higher fasting glucose stratum were more than double the corresponding hazard ratios in the lower stratum, whether using impaired fasting glucose or upper quartile fasting glucose as the cut point. These results suggest that an adverse synergistic interaction between glucose and cholesterol magnifies coronary heart disease risk associated with total cholesterol among hypertensive patients, raising the possibility that coronary heart disease prevention might be enhanced if cholesterol intervention criteria were modified by glucose status.

Adult↗
PubMed2004

Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.

OBJECTIVES: We report on a subanalysis of the effects of losartan and atenolol on cardiovascular events in black patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. BACKGROUND: The LIFE study compared losartan-based to atenolol-based therapy in 9,193 hypertensive patients with left ventricular hypertrophy (LVH). Overall, the risk of the primary composite end point (cardiovascular death, stroke, myocardial infarction) was reduced by 13% (p = 0.021) with losartan, with similar blood pressure (BP) reduction in both treatment groups. There was a suggestion of interaction between ethnic background and treatment (p = 0.057). METHODS: Exploratory analyses were performed that placed LIFE study patients into black (n = 533) and non-black (n = 8,660) categories, overall, and in the U.S. (African American [n = 523]; non-black [n = 1,184]). RESULTS: A significant interaction existed between the dichotomized groups (black/non-black) and treatment (p = 0.005); a test for qualitative interaction was also significant (p = 0.016). The hazard ratio (losartan relative to atenolol) for the primary end point favored atenolol in black patients (1.666 [95% confidence interval (CI) 1.043 to 2.661]; p = 0.033) and favored losartan in non-blacks (0.829 [95% CI 0.733 to 0.938]; p = 0.003). In black patients, BP reduction was similar in both groups, and regression of electrocardiographic-LVH was greater with losartan. CONCLUSIONS: Results of the subanalysis are sufficient to generate the hypothesis that black patients with hypertension and LVH might not respond as favorably to losartan-based treatment as non-black patients with respect to cardiovascular outcomes, and do not support a recommendation for losartan as a first-line treatment for this purpose. The subanalysis is limited by the relatively small number of events.

Aged↗
PubMed2004

Plasma renin activity levels in hypertensive persons: their wide range and lack of suppression in diabetic and in most elderly patients.

BACKGROUND: The renin-angiotensin system (RAS) maintains hemodynamic integrity by modulating both volume and vasoconstriction through a cybernetic feedback control mechanism. In addition, angiotensin II, the active component of the RAS, can be vasculotoxic and, in hypertensive individuals, is associated with increased cardiovascular morbidity and mortality. The objective of this study was to determine the distribution and determinants of plasma renin activity (PRA) in a representative sample of hypertensive persons. METHODS: We systematically measured PRA in 4170 untreated participants in a systematic work site-based, hypertension treatment program. RESULTS: In this multiethnic employed population, patients were classified as follows: low renin, <0.65 ng/mL/h (30% of the sample); medium renin, 0.66 to 4.5 mg/mL/h (60%); or high renin, >4.5 ng/mL/h (10%). Low renin patients were more likely to be African American, female, and slightly older. However, the majority of women and African American individuals were not low renin. The 469 diabetic subjects distributed across renin categories, as did the group as a whole. CONCLUSIONS: This systematic study of PRA in a large community sample of hypertensive patients reveals a wide distribution of activity level, with identifiable differences according to ethnicity, age, and sex but not diabetic status. However, these demographic differences were more quantitative than qualitative and do not provide a useful basis for estimation of the activity of the RAS. Instead, in hypertensive subjects, direct measurement of PRA is necessary, both for prognosis and for guiding hypertensive therapy.

Age Factors↗
PubMed2004

Dietary sodium and cardiovascular health in hypertensive patients: the case against universal sodium restriction.

Salt and BP have been linked for more than a century. Recent data indicate that, given free access to sodium, in most populations, intake is between 100 and 200 mmol/d, although individual variation is wide. There is good evidence that individual differences are influenced by genetics, environment, and behavior. There is also solid clinical trial data suggesting that substantial reduction in sodium intake (75 to 100 mmol/d) will, on average, lower diastolic pressure by approximately 1 mmHg and systolic by approximately 3 to 5 mmHg. In addition, there is good evidence that sodium restriction is accompanied by other hemodynamic and nonhemodynamic effects. The health effect of sodium restriction can be assessed only by outcome study in humans. The best available evidence in this regard derives from observational study. The several available studies in the general population are inconsistent and demonstrate heterogeneity across subgroups in the relation of sodium intake to cardiovascular morbidity and mortality. Only a single study has been reported in hypertensive patients that links baseline sodium, measured by 24-h urinary excretion, and subsequent cardiovascular outcomes. In that study, controlling for other risk factors, there was a significant, independent, inverse association of urinary sodium excretion and coronary morbidity and mortality. Indeed, an increase of 66 mmol/24 h was associated with a 36% reduction in events. Taken together, these data provide no support for the notion that either normotensive or hypertensive individuals should routinely decrease (or increase) dietary sodium intake.

Cardiovascular Diseases↗
PubMed2004

The impact of serum uric acid on cardiovascular outcomes in the LIFE study.

BACKGROUND: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study demonstrated the superiority of a losartan-based regimen over atenolol-based regimen for reduction of cardiovascular (CV) morbidity and mortality. It has been suggested that the LIFE study results may be related to the effects of losartan on serum uric acid (SUA). SUA has been proposed as an independent risk factor for CV morbidity and death. METHODS: Cox regression analysis was used to assess relationship of SUA and treatment regimens with the LIFE primary composite outcome (CV death, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke). RESULTS: Baseline SUA was significantly associated with increased CV events [hazard ratio (HR) 1.024 (95% CI 1.017-1.032) per 10 micromol/L, P < 0.0001] in the entire study population. The association was significant in women [HR = 1.025 (1.013-1.037), P < 0.0001], but not in men [HR = 1.009 (0.998-1.019), P= 0.108]. After adjustment for Framingham risk score (FRS), SUA was no longer significant in the entire study population [HR = 1.006 (0.998-1.014), P= 0.122] or in men [HR = 1.006 (0.995-1.017), P= 0.291], but was significant in women [HR = 1.013 (1-1.025), P= 0.0457]. The baseline-to-end-of-study increase in SUA (standard deviation, SD) was greater (P < 0.0001) in atenolol-treated subjects (44.4 +/- 72.5 micromol/L) than in losartan-treated subjects (17.0 +/- 69.8 micromol/L). SUA as a time-varying covariate was strongly associated with events (P < 0.0001) in the entire population. The contribution of SUA to the treatment effect of losartan on the primary composite end point was 29% (14%-107%), P= 0.004. The association between time-varying SUA and increased CV risk tended to be stronger in women (P < 0.0001) than in men (P= 0.0658), although the gender-outcome interaction was not significant (P= 0.079). CONCLUSION: The increase in SUA over 4.8 years in the LIFE study was attenuated by losartan compared with atenolol treatment, appearing to explain 29% of the treatment effect on the primary composite end point. The association between SUA and events was stronger in women than in men with or without adjustment of FRS.

Aged↗
PubMed2004

Does supplemental private insurance affect care of Medicare recipients hospitalized for myocardial infarction?

OBJECTIVES: We sought to determine whether supplemental private insurance coverage among Medicare recipients alters patterns of health care or outcomes associated with acute myocardial infarction. METHODS: Medicare patients hospitalized after a myocardial infarction were identified from New York City hospitalization records. Patients who had only Medicare coverage were compared with those who had supplemental private or public insurance coverage. RESULTS: Patients with supplemental private insurance exhibited increased rates of revascularization and decreased rates of in-hospital mortality relative to patients with either Medicare only or Medicare and public insurance. Moreover, Blacks and women were less likely to undergo revascularization and exhibited higher in-hospital mortality rates. CONCLUSIONS: Despite Medicare, private insurance coverage appears to influence the likelihood of coronary revascularization among older patients hospitalized for acute myocardial infarction.

Aged↗
PubMed2004

Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City.

Hip fractures are a major cause of death and disability among the elderly. Although previous studies have shown hip fracture rates to be highest among Whites, and lowest among Blacks, less is known about how these differences are affected by gender and age. We determined the hip fracture hospitalization rates for non-Hispanic Whites, Blacks, Hispanics, and Asians in New York City from 1988 to 2002 using Statewide Planning and Resource Cooperative System data from the New York state Department of Health. We found that hip fracture hospitalization rates for those aged 50 and older were higher for women than men, with a risk ratio of 1.75 (95% confidence interval [CI] 1.73-1.77). Annual age-adjusted hip fracture hospitalization rates among White, Black, Hispanic, and Asian women were 459, 137, 143, and 174 per 100,000, respectively. The corresponding rates for men were 230, 109, 87, and 104, respectively. For both genders, and all race/ethnicity groups, the rates increased sharply with age. Although overall, women had higher rates compared to men, these differences varied by race and age. For Whites and Asians, women had higher rates for all age groups older than 50 years. For Hispanics aged 50-59, men had a higher rate than did women, but this gender relationship reversed after age 60. For Blacks, however, men had higher rates than women until age 70, after which women had higher rates. These results demonstrate that race/ethnicity, as well as age and gender, influence the incidence of hip fractures. Moreover, Asians, with their low bone mass, showed no increased hip fractures, compared to non-Hispanic Blacks and Hispanics. Further study is needed to explain this paradox.

Black or African American↗
PubMed2004

Clinical characteristics of stroke among Chinese in New York City.

BACKGROUND: Limited information exists on clinical characteristics of stroke among Chinese persons living in the United States. We compared the clinical characteristics of Chinese and White stroke patients living in New York City. METHODS: We reviewed the medical records of stroke patients hospitalized at NYU Downtown Hospital from January 1995 to July 1998. RESULTS: During 3.5 years, there were 728 admissions for stroke (454 Chinese, 115 Whites, 75 Blacks, 80 Hispanics, and 4 other Asia). Chinese and White patients had similar age and gender distributions. Compared with Whites, Chinese patients had a lower body mass index (22.8 vs 25.8, respectively, P=0.02), were less likely to smoke (13% vs 20%, respectively, P<0.01), or regularly consume alcohol (8% vs 25%, respectively, P<0.01). Although recorded blood pressure was similar, Chinese patients were more likely than Whites to have a history of hypertension (77% vs 64%, respectively, P=0.03), left ventricular hypertrophy (37% vs 25%, respectively. P=0.02), history of diabetes (33% vs 21%, respectively, P=0.01), and higher levels of blood lipids and glucose. Chinese patients were more likely than Whites to have hemorrhagic stroke (24% vs 17%, respectively, P=0.02). Overall age-adjusted in-hospital mortality rate was 14.2%, and no significant difference was observed between Chinese and Whites (13.8% vs 14.8%, respectively, P=0.1). For both races, hemorrhagic stroke was far more likely to be fatal than ischemic stroke (34.5% vs 6.1%, respectively, P<0.001). Factors associated with in-hospital death included systolic blood pressure, blood glucose level, history of coronary heart disease, and diabetes. CONCLUSIONS: Chinese patients who suffered a stroke showed higher risk profiles, and were more likely to experience a more lethal hemorrhagic stroke, compared to White patients. The short-term in-hospital survival rates were similar between Chinese and White patients with stroke.

Adult↗
PubMed2003

The return on INVEST.

Explore the source record for details and available documents.

Adrenergic beta-Antagonists↗
PubMed2003

Is geography destiny for patients in New York with myocardial infarction?

PURPOSE: The use of coronary revascularization among patients with myocardial infarction varies by race/ethnicity and socioeconomic status. The objective of this study was to determine whether local availability of facilities might influence apparent racial disparities in revascularization and health outcomes. METHODS: Using Statewide Planning and Research Cooperative System data (1988-1999) from the New York State Department of Health, we determined revascularization rates among patients hospitalized with myocardial infarction in two socioeconomically disadvantaged communities in New York City (the South Bronx, which has no hospitals that have revascularization facilities, and Harlem, which has three revascularization facilities), as well as in its most advantaged community (mid-Manhattan, which has six such facilities). The rest of New York City served as reference. We measured demographic and clinical characteristics and revascularization rates in each community. RESULTS: Among patients hospitalized with myocardial infarction, the age-adjusted revascularization rates were 29.2% for whites, 12.5% for blacks, and 19.9% for Hispanics (P <0.01). Rates were 12.0% in the South Bronx, 24.0% in Harlem, 38.4% in mid-Manhattan, and 21.2% in the rest of New York City (P <0.05). Logistic regression analysis, adjusting for age, sex, race, insurance status, comorbidity, clinical complications, and year of admission, revealed that South Bronx patients were about 20% less likely to be revascularized than those in the rest of New York City, whereas patients living in Harlem were twice as likely to receive such treatment as residents in the rest of New York City. Among patients admitted to hospitals with cardiac revascularization facilities, lower use among South Bronx residents persisted, but after adjusting for patient characteristics, Harlem residents were significantly less likely to be revascularized than those from the rest of New York City. CONCLUSION: Race and socioeconomic factors influence the likelihood of revascularization after myocardial infarction among residents of New York City. In addition, lack of availability of revascularization further reduces its use by residents of disadvantaged neighborhoods.

Adult↗
PubMed2003

Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.

CONTEXT: Establishing relative benefit or harm from specific antihypertensive agents is limited by the complex array of studies that compare treatments. Network meta-analysis combines direct and indirect evidence to better define risk or benefit. OBJECTIVE: To summarize the available clinical trial evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major cardiovascular disease end points and all-cause mortality. DATA SOURCES AND STUDY SELECTION: We used previous meta-analyses, MEDLINE searches, and journal reviews from January 1995 through December 2002. We identified long-term randomized controlled trials that assessed major cardiovascular disease end points as an outcome. Eligible studies included both those with placebo-treated or untreated controls and those with actively treated controls. DATA EXTRACTION: Network meta-analysis was used to combine direct within-trial between-drug comparisons with indirect evidence from the other trials. The indirect comparisons, which preserve the within-trial randomized findings, were constructed from trials that had one treatment in common. DATA SYNTHESIS: Data were combined from 42 clinical trials that included 192 478 patients randomized to 7 major treatment strategies, including placebo. For all outcomes, low-dose diuretics were superior to placebo: coronary heart disease (CHD; RR, 0.79; 95% confidence interval [CI], 0.69-0.92); congestive heart failure (CHF; RR, 0.51; 95% CI, 0.42-0.62); stroke (RR, 0.71; 0.63-0.81); cardiovascular disease events (RR, 0.76; 95% CI, 0.69-0.83); cardiovascular disease mortality (RR, 0.81; 95% CI, 0.73-0.92); and total mortality (RR, 0.90; 95% CI, 0.84-0.96). None of the first-line treatment strategies-beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, and angiotensin receptor blockers-was significantly better than low-dose diuretics for any outcome. Compared with CCBs, low-dose diuretics were associated with reduced risks of cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00) and CHF (RR, 0.74; 95% CI, 0.67-0.81). Compared with ACE inhibitors, low-dose diuretics were associated with reduced risks of CHF (RR, 0.88; 95% CI, 0.80-0.96), cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00), and stroke (RR, 0.86; 0.77-0.97). Compared with beta-blockers, low-dose diuretics were associated with a reduced risk of cardiovascular disease events (RR, 0.89; 95% CI, 0.80-0.98). Compared with alpha-blockers, low-dose diuretics were associated with reduced risks of CHF (RR, 0.51; 95% CI, 0.43-0.60) and cardiovascular disease events (RR, 0.84; 95% CI, 0.75-0.93). Blood pressure changes were similar between comparison treatments. CONCLUSIONS: Low-dose diuretics are the most effective first-line treatment for preventing the occurrence of cardiovascular disease morbidity and mortality. Clinical practice and treatment guidelines should reflect this evidence, and future trials should use low-dose diuretics as the standard for clinically useful comparisons.

Humans↗
PubMed2003

Differential use of coronary revascularization and hospital mortality following acute myocardial infarction.

BACKGROUND: The effect of racial/ethnic disparity in the use of cardiac procedures on short-term outcomes, such as hospital mortality, is limited. We sought to determine the association of revascularization procedures (percutaneous transluminal coronary angioplasty or coronary artery bypass graft) to hospital mortality in non-Hispanic black and white patients and Hispanic patients with acute myocardial infarction. METHODS: Analysis of the New York State Department of Health Statewide Planning and Research Cooperate System (SPARCS) data for 12 555 patients admitted to New York City hospitals with acute myocardial infarction in 1996. Revascularization procedure frequencies and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hospital mortality were calculated. RESULTS: Whites were older than Hispanics and blacks (mean +/- SD age, 70 +/- 13.3 vs 64 +/- 13.3 and 64 +/- 12.9 years, respectively; P<.001) and more likely to have heart failure (36.3% vs 29.1% and 29.6%, respectively; P<.001). Blacks were least likely to be revascularized compared with Hispanics and whites (15.8% vs 25.8% and 25.2%, respectively; P<.001). Hispanics were more likely to survive than whites (adjusted OR, 0.73 [95% CI, 0.59-0.91]); this difference was not significant for blacks (adjusted OR, 0.83 [95% CI, 0.69-1.00]). Nonrevascularized blacks and Hispanics were more likely to be discharged alive than nonrevascularized whites (OR, 0.80 [95% CI, 0.66-0.98] for blacks; OR, 0.74 [95% CI, 0.59-0.93] for Hispanics). There were no significant racial/ethnic differences in hospital survival among revascularized patients. CONCLUSIONS: Nonclinical and clinical factors appear to account for blacks being least likely to have been revascularized. Despite these differences in revascularization rates, survival was similar for blacks and whites, whereas Hispanics were more likely to survive than whites.

Black or African American↗
PubMed2003

Exercise, body mass index, caloric intake, and cardiovascular mortality.

BACKGROUND: The association of physical inactivity and elevated body mass index (BMI) with cardiovascular disease (CVD) risk is well established. The relationship of dietary caloric intake and CVD risk is less certain. METHODS: The epidemiologic follow-up of the First National Health and Nutrition Examination Survey (1971-1992) was examined to determine the relationship of caloric intake, BMI, and physical activity to CVD mortality. Of 14,407 participants, 9790 subjects aged 25 to 74 years met inclusion criteria. The CVD mortality rate was the outcome. RESULTS: During the 17 years of follow-up, there were 3183 deaths, 1531 of which were due to CVD (9.11/1000 person-years). People with relatively less physical activity, lower caloric intake, and who were overweight (BMI 25 to 29.9 kg/m(2)) and obese (BMI > or =30 kg/m(2)) had a less favorable baseline CVD risk profile than did those who were more active and of normal weight and had greater caloric intake. Age- and race/ethnicity-adjusted CVD mortality rates were highest among those with the least physical activity and lowest caloric intake, and who were overweight or obese. Moreover, subjects of normal weight who exercised most were more likely to have high caloric intake and lower CVD mortality (5.9 vs 14.7 per 1000 person-years, p =0.01) than subjects who were obese and exercised least. In Cox regression analysis, controlling for relevant CVD risk factors, least physical activity was independently associated with increased CVD mortality (hazard ratio=1.32, 95% confidence interval [CI]=1.13-1.53); and obesity was associated with increased CVD mortality (hazard ratio=1.24, 95% CI=1.06-1.44). Although highest dietary caloric intake was associated with reduced CVD mortality (hazard ratio=0.83, 95% CI=0.74-0.93), after adjusting for physical activity and BMI, there was no significant association of highest caloric intake with CVD mortality (hazard ratio=0.91, 95% CI=0.81-1.01). CONCLUSIONS: In this large general population sample, lower levels of physical activity and obesity were independently associated with decreased CVD survival. Moreover, when BMI, physical activity, and other relevant characteristics were taken into account, caloric intake was not related to CVD mortality.

Adult↗
PubMed2003

ALLHAT and beyond.

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Antihypertensive Agents↗
PubMed2002

Dissociation of hospitalization and mortality trends for myocardial infarction in the United States from 1988 to 1997.

PURPOSE: Although age-adjusted mortality from myocardial infarction in the United States has declined during the past few decades, changes in the incidence of myocardial infarction are less certain. To address this issue, we evaluated trends in hospitalization for, and in-hospital mortality from, myocardial infarction from 1988 to 1997. METHODS: Hospitalization rates were determined by age and sex using data from the National Hospital Discharge Survey and the Current Population Survey. Comorbid conditions, complications, use of cardiac procedures, and in-hospital mortality were measured. In-hospital mortality was estimated after adjusting for associated risk factors, complications, use of invasive diagnostic and therapeutic procedures, and length of stay. RESULTS: Age-adjusted rates of hospitalization for myocardial infarction were 525 per 100,000 in 1988 and 482 per 100,000 in 1997, with a mean annual decline of 0.8% (P = 0.32). Mortality declined from 58 per 100,000 in 1988 to 40 per 100,000 in 1997, a mean annual decline of 4.2% (P = 0.01). During these 10 years, although the median hospital stay for myocardial infarction decreased from 8 to 5 days, the intensity of hospital care increased, including use of angiography from 20% to 31% (P = 0.04) and revascularization from 16% to 31% (P = 0.004). Age-adjusted in-hospital mortality decreased by nearly half, from 7.6% in 1988 to 3.9% in 1997 (P = 0.006). CONCLUSION: During the past decade, the decline in mortality from myocardial infarction in the United States has not been accompanied by a decline in hospitalization rate. At the same time, there has been a marked increased in the use of cardiac revascularization.

Adult↗