Pub Date : 2024-12-29DOI: 10.1016/j.mayocp.2024.10.005
Niloofar Nobakht, Yalda Afshar, Marmar Vaseghi, Zhaoping Li, Ines Donangelo, Helen Lavretsky, Thalia Mok, Christina S Han, Susanne B Nicholas
Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups. Despite our current understanding of underlying mechanisms and strategies to manage hypertension in women, numerous challenges remain. Here, we discuss potential factors contributing to hypertension in women, differences related to effects of lifestyle modifications and drug therapy between men and women, the impact of sleep, and the importance of recognizing disparities in socioeconomic conditions and access to care. This review outlines several opportunities for future studies to fill gaps in knowledge to achieve optimal control of hypertension in women using a multidisciplinary approach, particularly related to sex-specific treatment approaches while considering socioeconomic conditions and life stages from premenopause through the transition to menopause.
{"title":"Hypertension Management in Women With a Multidisciplinary Approach.","authors":"Niloofar Nobakht, Yalda Afshar, Marmar Vaseghi, Zhaoping Li, Ines Donangelo, Helen Lavretsky, Thalia Mok, Christina S Han, Susanne B Nicholas","doi":"10.1016/j.mayocp.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.005","url":null,"abstract":"<p><p>Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups. Despite our current understanding of underlying mechanisms and strategies to manage hypertension in women, numerous challenges remain. Here, we discuss potential factors contributing to hypertension in women, differences related to effects of lifestyle modifications and drug therapy between men and women, the impact of sleep, and the importance of recognizing disparities in socioeconomic conditions and access to care. This review outlines several opportunities for future studies to fill gaps in knowledge to achieve optimal control of hypertension in women using a multidisciplinary approach, particularly related to sex-specific treatment approaches while considering socioeconomic conditions and life stages from premenopause through the transition to menopause.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mayocp.2024.10.015
Karl A. Nath MBChB (Editor-in-Chief)
{"title":"In the Limelight: December 2024","authors":"Karl A. Nath MBChB (Editor-in-Chief)","doi":"10.1016/j.mayocp.2024.10.015","DOIUrl":"10.1016/j.mayocp.2024.10.015","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 12","pages":"Pages 1851-1853"},"PeriodicalIF":6.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mayocp.2024.07.008
Kajal P. Shah MD , Christopher Lee MD , Robert D. McBane MD , Gregory Piazza MD , Robert P. Frantz MD , Damon E. Houghton MD , Ana I. Casanegra MD , Stanislav Henkin MD
Historically, research on pulmonary embolism (PE) management has focused on short-term outcomes, such as acute cardiovascular collapse, change in right ventricular function, and in-hospital mortality. However, long-standing functional impairments from acute PE occur in up to half of all patients. This chronic syndrome has been termed the post-PE syndrome, which describes patients who have persistent or worsening symptoms, functional limitations, and cardiorespiratory impairment not explained by a comorbid condition. Diagnosis and management are challenging, and post-PE syndrome remains an underrecognized and undertreated condition. This review seeks to increase awareness of the syndrome that affects a significant portion of PE survivors. The epidemiology, pathophysiology, and clinical features are discussed, followed by a description of imaging findings and management options across the entire spectrum of post-PE syndrome.
一直以来，有关肺栓塞（PE）治疗的研究都侧重于短期结果，如急性心血管衰竭、右心室功能变化和院内死亡率。然而，多达一半的患者会因急性 PE 而出现长期功能障碍。这种慢性综合征被称为 PE 后综合征，是指患者的症状、功能限制和心肺功能损害持续存在或恶化，而合并症无法解释其原因。诊断和管理具有挑战性，PE 后综合征仍未得到充分认识和治疗。本综述旨在提高人们对影响大部分 PE 幸存者的综合征的认识。本综述讨论了 PE 后综合征的流行病学、病理生理学和临床特征，随后介绍了 PE 后综合征整个病程的影像学检查结果和治疗方案。
{"title":"Post–Pulmonary Embolism Syndrome—A Diagnostic Dilemma and Challenging Management","authors":"Kajal P. Shah MD , Christopher Lee MD , Robert D. McBane MD , Gregory Piazza MD , Robert P. Frantz MD , Damon E. Houghton MD , Ana I. Casanegra MD , Stanislav Henkin MD","doi":"10.1016/j.mayocp.2024.07.008","DOIUrl":"10.1016/j.mayocp.2024.07.008","url":null,"abstract":"<div><div>Historically, research on pulmonary embolism (PE) management has focused on short-term outcomes, such as acute cardiovascular collapse, change in right ventricular function, and in-hospital mortality. However, long-standing functional impairments from acute PE occur in up to half of all patients. This chronic syndrome has been termed the post-PE syndrome, which describes patients who have persistent or worsening symptoms, functional limitations, and cardiorespiratory impairment not explained by a comorbid condition. Diagnosis and management are challenging, and post-PE syndrome remains an underrecognized and undertreated condition. This review seeks to increase awareness of the syndrome that affects a significant portion of PE survivors. The epidemiology, pathophysiology, and clinical features are discussed, followed by a description of imaging findings and management options across the entire spectrum of post-PE syndrome.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 12","pages":"Pages 1965-1982"},"PeriodicalIF":6.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mayocp.2024.08.007
Mohammad Abdel Jawad MD , James H. O’Keefe MD , Nathan Tintle PhD , Evan L. O’Keefe MD , W. Grant Franco MD , Luc Djousse MD, ScD, MPH , Nathan Ryder PhD , William S. Harris PhD
Objective
To investigate the association between plasma omega-3 levels and incident heart failure (HF) and to examine their relationship with total and cardiovascular (CV) mortality among patients with preexisting HF.
Patients and Methods
The UK Biobank is an ongoing prospective cohort study of individuals recruited in the United Kingdom between April 1, 2007, and December 31. 2010. We used Cox proportional hazards models to predict incident HF in those without baseline HF and total and CV mortality in those with baseline HF, all as a function of baseline plasma omega-3 levels.
Results
In participants without HF at baseline (n=271,794), a generally linear inverse association was observed between omega-3 levels and incident HF during a median follow-up of 13.7 years. The risk was 21% lower in the highest quintile of omega-3 compared with the lowest quintile (hazard ratio, 0.79; 95% CI, 0.74 to 0.84; P<.001) in multivariable models. In parallel models in participants with prevalent HF (n=1239), risk for all-cause and CV mortality were both reduced by approximately 50% comparing top to bottom omega-3 quintiles (hazard ratio, 0.53; 95% CI, 0.33 to 0.86; and hazard ratio, 0.50; 95% CI, 0.31 to 0.79, respectively; both P<.01).
Conclusion
Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of HF. Furthermore, among patients with preexisting HF, higher omega-3 levels were associated with lower risks of all-cause mortality and CV mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of HF and death in those with prevalent HF.
{"title":"Association of Plasma Omega-3 Levels With Incident Heart Failure and Related Mortalities","authors":"Mohammad Abdel Jawad MD , James H. O’Keefe MD , Nathan Tintle PhD , Evan L. O’Keefe MD , W. Grant Franco MD , Luc Djousse MD, ScD, MPH , Nathan Ryder PhD , William S. Harris PhD","doi":"10.1016/j.mayocp.2024.08.007","DOIUrl":"10.1016/j.mayocp.2024.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between plasma omega-3 levels and incident heart failure (HF) and to examine their relationship with total and cardiovascular (CV) mortality among patients with preexisting HF.</div></div><div><h3>Patients and Methods</h3><div>The UK Biobank is an ongoing prospective cohort study of individuals recruited in the United Kingdom between April 1, 2007, and December 31. 2010. We used Cox proportional hazards models to predict incident HF in those without baseline HF and total and CV mortality in those with baseline HF, all as a function of baseline plasma omega-3 levels.</div></div><div><h3>Results</h3><div>In participants without HF at baseline (n=271,794), a generally linear inverse association was observed between omega-3 levels and incident HF during a median follow-up of 13.7 years. The risk was 21% lower in the highest quintile of omega-3 compared with the lowest quintile (hazard ratio, 0.79; 95% CI, 0.74 to 0.84; <em>P</em><.001) in multivariable models. In parallel models in participants with prevalent HF (n=1239), risk for all-cause and CV mortality were both reduced by approximately 50% comparing top to bottom omega-3 quintiles (hazard ratio, 0.53; 95% CI, 0.33 to 0.86; and hazard ratio, 0.50; 95% CI, 0.31 to 0.79, respectively; both <em>P</em><.01).</div></div><div><h3>Conclusion</h3><div>Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of HF. Furthermore, among patients with preexisting HF, higher omega-3 levels were associated with lower risks of all-cause mortality and CV mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of HF and death in those with prevalent HF.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 12","pages":"Pages 1895-1904"},"PeriodicalIF":6.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mayocp.2024.09.014
Luca Fazzini MD , Matteo Castrichini MD , Melanie C. Bois MD, Neena Natt MD, Ian C. Chang MD, Martha Grogan MD, Naveen L. Pereira MD, Omar F. AbouEzzeddine MD
{"title":"Severe Hypothyroidism—A Less Known Mimicker of Amyloid Cardiomyopathy?","authors":"Luca Fazzini MD , Matteo Castrichini MD , Melanie C. Bois MD, Neena Natt MD, Ian C. Chang MD, Martha Grogan MD, Naveen L. Pereira MD, Omar F. AbouEzzeddine MD","doi":"10.1016/j.mayocp.2024.09.014","DOIUrl":"10.1016/j.mayocp.2024.09.014","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 12","pages":"Pages 2008-2011"},"PeriodicalIF":6.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mayocp.2024.08.005
Lorelei A. Bandel MBA , Robert A. Vierkant MS , Teresa M. Kruisselbrink MS, CGC , Michelle L. Bublitz MHA, CCRP , Tammy A. Wilson , Sebastian M. Armasu MS, MA , Jan B. Egan PhD , Richard J. Presutti DO , Niloy Jewel J. Samadder MD , Aleksandar Sekulic MD PhD , Rory J. Olson PhD , Jennifer Tan-Arroyo PhD , Joel A. Morales-Rosado MD , Eric W. Klee PhD , Matthew J. Ferber PhD , Jennifer L. Kemppainen MS, CGC , Jennifer L. Anderson MS, CGC , Jessa S. Bidwell MS, CGC , Joseph J. Wick , Victor E. Ortega MD, PhD , Konstantinos N. Lazaridis MD
Objective
To execute a large-scale, decentralized, clinical-grade whole exome sequencing study, coined Tapestry, for clinical practice, research discovery, and genomic education.
Patients and Methods
Between July 1, 2020, and May 31, 2024, we invited 1,287,608 adult Mayo Clinic patients to participate in Tapestry. Of those contacted, 114,673 patients were consented and 98,222 (65.2% women) are currently enrolled: 62,495 (63.6%) were recruited from Minnesota-, 18,353 (18.7%) from Florida- and 17,374 (17.7%) from Arizona-based practices. Saliva from participants was used to extract DNA, and whole exome sequencing plus ∼300,000 single nucleotide polymorphisms (ie, Exome+ assay) were sequenced by a clinical lab. Results for the Centers for Disease Control and Prevention Tier 1 genes (eg, hereditary breast, ovarian cancer syndrome: BRCA1/2; Lynch syndrome: MLH1, MSH2, MSH6, PMS2, and EPCAM; and familial hypercholesterolemia: APOB, LDLR, PCSK9, and LDLRAP1) were interpreted and entered into the electronic health record.
Results
The median age of participants was 59.1 years and ∼11% were from racial/ethnic groups under-represented in research. One thousand eight hundred nineteen (1.9%) participants had actionable pathogenic or likely pathogenic variants (50.0% BRCA1/2, 28.4% familial hypercholesterolemia, and 22.2% Lynch syndrome). Positive results were communicated by genetic counselors who educated patients and providers. Thus far, 62,758 patients’ Exome+ assays are stored for research, and the Tapestry Data Access Committee has received 118 requests from investigators, of which 82 have been approved, resulting in the delivery of 1,117,410 Exome+ assays to researchers.
Conclusion
A large, decentralized, clinical Exome+ assay study in a tertiary medical center detects actionable germline variants, educates patients as well as providers, and offers access to big data for discovery that advances human health.
{"title":"Mayo Clinic Tapestry Study","authors":"Lorelei A. Bandel MBA , Robert A. Vierkant MS , Teresa M. Kruisselbrink MS, CGC , Michelle L. Bublitz MHA, CCRP , Tammy A. Wilson , Sebastian M. Armasu MS, MA , Jan B. Egan PhD , Richard J. Presutti DO , Niloy Jewel J. Samadder MD , Aleksandar Sekulic MD PhD , Rory J. Olson PhD , Jennifer Tan-Arroyo PhD , Joel A. Morales-Rosado MD , Eric W. Klee PhD , Matthew J. Ferber PhD , Jennifer L. Kemppainen MS, CGC , Jennifer L. Anderson MS, CGC , Jessa S. Bidwell MS, CGC , Joseph J. Wick , Victor E. Ortega MD, PhD , Konstantinos N. Lazaridis MD","doi":"10.1016/j.mayocp.2024.08.005","DOIUrl":"10.1016/j.mayocp.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>To execute a large-scale, decentralized, clinical-grade whole exome sequencing study, coined Tapestry, for clinical practice, research discovery, and genomic education.</div></div><div><h3>Patients and Methods</h3><div>Between July 1, 2020, and May 31, 2024, we invited 1,287,608 adult Mayo Clinic patients to participate in Tapestry. Of those contacted, 114,673 patients were consented and 98,222 (65.2% women) are currently enrolled: 62,495 (63.6%) were recruited from Minnesota-, 18,353 (18.7%) from Florida- and 17,374 (17.7%) from Arizona-based practices. Saliva from participants was used to extract DNA, and whole exome sequencing plus ∼300,000 single nucleotide polymorphisms (ie, Exome+ assay) were sequenced by a clinical lab. Results for the Centers for Disease Control and Prevention Tier 1 genes (eg, hereditary breast, ovarian cancer syndrome: <em>BRCA1/2</em>; Lynch syndrome: <em>MLH1, MSH2, MSH6, PMS2</em>, and <em>EPCAM</em>; and familial hypercholesterolemia: <em>APOB, LDLR, PCSK9,</em> and <em>LDLRAP1</em>) were interpreted and entered into the electronic health record.</div></div><div><h3>Results</h3><div>The median age of participants was 59.1 years and ∼11% were from racial/ethnic groups under-represented in research. One thousand eight hundred nineteen (1.9%) participants had actionable pathogenic or likely pathogenic variants (50.0% <em>BRCA1/2</em>, 28.4% familial hypercholesterolemia, and 22.2% Lynch syndrome). Positive results were communicated by genetic counselors who educated patients and providers. Thus far, 62,758 patients’ Exome+ assays are stored for research, and the Tapestry Data Access Committee has received 118 requests from investigators, of which 82 have been approved, resulting in the delivery of 1,117,410 Exome+ assays to researchers.</div></div><div><h3>Conclusion</h3><div>A large, decentralized, clinical Exome+ assay study in a tertiary medical center detects actionable germline variants, educates patients as well as providers, and offers access to big data for discovery that advances human health.</div></div><div><h3>Trial Registration</h3><div>clinicaltrials.gov Identifier: <span><span>NCT05212428</span><svg><path></path></svg></span></div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 12","pages":"Pages 1878-1894"},"PeriodicalIF":6.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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