donald grandis m d a real life case presentation
play

Donald Grandis, M.D, A Real Life Case Presentation M.F. is a 64 year old woman with no history of high blood pressure, diabetes mellitus, high cholesterol, or cigarette smoking. She developed severe chest pain on the evening of 01/14/08

0 downloads 3 Views 1,12 MB Size Report
  1. Donald Grandis, M.D,

  2. A Real Life Case Presentation � M.F. is a 64 year old woman with no history of high blood pressure, diabetes mellitus, high cholesterol, or cigarette smoking. � She developed severe chest pain on the evening of 01/14/08 and presented to the Emergency Department the following morning. The diagnosis of an Acute Myocardial Infarction (heart attack) was made. � She underwent an emergency coronary angioplasty and has done well since.

  3. Cardiovascular Disease Facts � Cardiovascular Disease remains the leading cause of death in the U.S. � Approx. 800,000 Myocardial Infarctions occur each year in the U.S. � Annual Cost is $76 billion. � Risk factors include age, smoking, high cholesterol, high blood pressure, diabetes mellitus, and male gender. � 50% of patients have “normal” cholesterol levels and 20% have no known major risk factors.

  4. Air Pollution as Risk Factor for Cardiovascular Disease � Dublin, Ireland banned coal sales 1990, reduced black smoke 35.6 µ g/mm 3 and saw an associated 10.3% annual reduction in cardiovascular mortality. � Based on over 15 studies worldwide, an increase in PM 10 of 10 µ g/mm 3 increases cardiovascular mortality 1.4% � In the US, during 24 hours, for each increase of 10 µ g/mm 3 in PM 10 , cardiovascular mortality increases 0.2% � A study in Allegheny County in 2004 found that an increase in PM 10 of 10 µ g/mm 3 increased the chances of admission for heart failure by 3%.

  5. Allegheny County, Pennsylvania 2007

  6. Limitations � Relative to other conventional risk factors, the risk of poor air quality causing cardiovascular disease is relatively low for a given individual. � Studies are associations, not causation. � Other factors such as lower income , education level, and lifestyle may be more prevalent in those with higher air pollution exposure. These factors might confound the findings. � “Harvesting”

  7. Possible Effects of Air Pollution on Human Physiology � PM 10 particles and smaller are small enough to cross from lungs into blood stream. � PM 10 particles raise blood pressure. � PM 2.5 particles raise blood levels of CRP. � Diesel Exhaust raises blood levels of IL-6. � PM 2.5 particles raise activation of the nervous system which can lead to heart rhythm abnormalities. � PM 2.5 particles raise blood levels of fibrinogen . � PM 2.5 particle exposure increases vascular resistance

  8. Role of Inflammation on Risk of Cardiovascular Events

  9. In January 2008, when M.F. suffered her heart attack, the EPA air quality monitors were listed as orange (50 – 100 µ g/mm 3 ).

  10. Changes in Life Expectancy for the 1980s-1990s, Plotted against Reductions in PM2.5 Concentrations for 1980-2000 Pope C et al. N Engl J Med 2009;360:376-386

  11. Conclusion � As levels of PM 10 and PM 2.5 increase, the risk of death or hospitalization from cardiovascular disease increases. � The relative risk of cardiovascular disease due to poor air quality is less than that of conventional risk factors for the nation overall. However , the levels of PM 2.5 that are seen in Allegheny County generate risks similar to those seen with conventional risk factors � Unlike conventional risk factors which affect some of the population, air pollution affects everyone.

Recommend Documents


g r a n d i s
G R A N D I S Artisan Manufacturers

Les Ateliers G R A N D I S Artisan Manufacturers www.grandis.fr Les Ateliers

clickhouse in real life
ClickHouse In Real Life Case Studies

ClickHouse In Real Life Case Studies and Best Practices Alexander Zaitsev,

life course of cardiovascular health prevention across
Life Course of Cardiovascular Health:

Life Course of Cardiovascular Health: Prevention Across the Ages Donald M.

assessing your cyber risk
Assessing your Cyber Risk A Real Life

Assessing your Cyber Risk A Real Life Case Study Presented by: Liz Limjuco,

real students real world real work real life a plan for a
Real Students Real World Real Work

Real Students Real World Real Work Real Life: A Plan for a Holistic

a journey towards real life results
A journey towards real-life results

A journey towards real-life results illustrated by using AI in Twitters

life after libor
LIFE AFTER LIBOR FINANCIAL EXECUTIVES

LIFE AFTER LIBOR FINANCIAL EXECUTIVES INTERNATIONAL PRESENTED BY: DONALD J.

c uneo i taly
C UNEO , I TALY I.I.S. S.GRANDIS CUNEO

C UNEO , I TALY I.I.S. S.GRANDIS CUNEO - ITALY CUNEO, THE ARCADES CITY Cuneo

g r a n d i s
G R A N D I S Art Artisan isan Man

G R A N D I S Art Artisan isan Man Manufa facturer turers of of Luxur

muddy waters
Muddy Waters Joey Betland Lindsay Cox

Muddy Waters Joey Betland Lindsay Cox Matt Rolchigo Donald Wilhite II

based on 2007 esrd medicare data
Based on 2007 ESRD Medicare data Total

ASDIN 7th Annual Scientific Meeting Based on 2007 ESRD Medicare data Total

optigauge precision thickness measurement
OptiGauge Precision Thickness

OptiGauge Precision Thickness Measurement July 2008 N ON - CONTACT MEASUREMENT

united states court of appeals for the federal circuit
United States Court of Appeals for the

United States Court of Appeals for the Federal Circuit 99-1499 SCIMED LIFE

cardiovascular research in dogs amp humans the clinician
Cardiovascular Research in Dogs &

Cardiovascular Research in Dogs & Humans : The Clinicians Perspective

equity of care
Equity of Care: All Payer Claims

The Business Case for Equity of Care: All Payer Claims Databases U.S. Chamber

fy 2020
FY 2020 IPPS/LTCH Final Rule HFMA

FY 2020 IPPS/LTCH Final Rule HFMA Executive Summary Overall Impact CMS

in hospital mortality with relation to time of
In-hospital Mortality with Relation to

ORIGINAL ARTICLE In-hospital Mortality with Relation to Time of Presentation

single payer amp universal coverage
Single-Payer & Universal Coverage

Washington Universal Single-Payer & Universal Coverage Health Care

4
4 5 By GREGORy A. CASTANIAS, PETER G.

4 5 By GREGORy A. CASTANIAS, PETER G. THURLOW & MICHAEL DALLAL he United

single stage management
Single-Stage Management of Dynamic

Single-Stage Management of Dynamic Malperfusion Utilizing a Novel Arch

2016 financial year
2016 financial year Yves Serra

Annual Media Conference 2016 financial year Yves Serra 28.02.2017 GF

medical device rew a clinician s perspective
MEDICAL DEVICE REW a clinicians

MEDICAL DEVICE REW a clinicians perspective INTERNATIONAL MEDICAL DEVICE