Objectives To evaluate longitudinal changes in six inflammatory markers that predict cardiovascular disease events among smokers making a quit attempt and to characterize their cross-sectional associations between smoking and smoking heaviness. Approach and Results In a longitudinal cohort study of contemporary smokers (N=1652), we evaluated (i) independent associations of smoking heaviness markers (exhaled carbon monoxide, cigarettes/day, pack-years) with inflammatory markers (C-reactive protein [CRP], D-dimer, fibrinogen, urinary F2 isoprostane:creatinine [F2:Cr] ratio, white blood cell count [WBC], myeloperoxidase [MPO]), and (ii) the effects of smoking cessation and continued smoking on these inflammatory markers after one year, among the 888 smokers who made an aided quit attempt as part of a randomized comparative effectiveness trial or standard care. There were strong, independent associations between smoking heaviness markers and the F2:Cr ratio, WBC, and MPO (all padj<0.001), but not hsCRP, D-dimer, or fibrinogen. Participants were mean (standard deviation) 49.6 (11.6) years old, 54% female, 34% non-White, and smoked 16.8 (8.5) cigarettes /day for 27.3 (18.6) pack-years. After 1 year, the 344 successful abstainers gained more weight (4.0 [6.0] vs. 0.4 [5.7] pounds, p<0.001) and had larger increases in insulin resistance scores (p=0.02) than continuing smokers. Despite these increases, abstainers had significant decreases in F2:Cr ratio (p<0.001) and WBC counts (p<0.001). Changes in other markers were not related to quitting. Conclusions Smoking heaviness is associated with increased F2:Cr ratio, MPO, and WBC counts. Cessation improves the F2:Cr ratio and WBC counts independent of weight change, suggesting reduced inflammation related to less oxidant stress.
Young adults (18–39 year-olds) have the lowest hypertension control rates compared to older adults. Shorter follow-up encounter intervals are associated with faster hypertension control rates in older adults; however, optimal intervals are unknown for young adults. Our objective was to evaluate the relationship between ambulatory blood pressure encounter intervals (average number of provider visits with blood pressures over time) and hypertension control rates among young adults with incident hypertension. A retrospective analysis was conducted of 18–39 year-olds (n=2990) with incident hypertension using Kaplan-Meier survival and Cox proportional hazards analyses over 24 months. Shorter encounter intervals were associated with higher hypertension control: <1 month (91%), 1–2 (76%), 2–3 (65%), 3–6 (40%), and >6 months (13%). Young adults with shorter encounter intervals also had lower medication initiation, supporting the effectiveness of lifestyle modifications. Sustainable interventions for timely young adult follow-up are essential to improve hypertension control in this hard-to-reach population.
Background: Young adults (18-39 years old) have the lowest rates of hypertension control compared to middle-aged and older adults. Shorter follow-up encounter intervals have been associated with faster rates of hypertension control in middle-aged and older adults. However, the optimal follow-up interval is not defined in younger adults. The objective was to evaluate the relationship between ambulatory follow-up intervals, defined as the average number of provider-patient blood pressure encounters over time, and rates of hypertension control among young adults with incident hypertension. Methods: This was a retrospective analysis of 3,150 young adults receiving regular primary care in a large, Midwestern, academic group practice from 2008-2011. Patients were included upon meeting JNC7 clinical criteria for hypertension (≥140/90 mmHg) and followed for 24 months. Young adults with a previous hypertension diagnosis or prior antihypertensive medication were excluded. We calculated the average blood pressure encounter interval over 24 months and categorized the intervals using established categories of <1 month, 1-2 months, 2-3 months, 3-6 months, and >6 month intervals. Summary statistics were constructed using frequencies and proportions for categorical data and median (25 th , 75 th percentile) for continuous variables. Univariate associations between continuous variables were assessed using two-sided t-test. The probability of achieving hypertension control (<140/90 mmHg) for patients within each encounter interval category was estimated by Kaplan-Meier analysis. Results: Among young adults with newly diagnosed hypertension (59% male, 83% White), those with the shortest average encounter interval (<1 month) were more likely to be female, have Stage 1 (mild) hypertension, Medicaid use, diabetes mellitus, and mental health diagnoses (all p<0.007). The likelihood of achieving hypertension control within 24 months was greater for shorter encounter intervals: <1 month (91%), 1-2 months (76%), 2-3 months (65%), 3-6 months (40%), and >6 months (13%), p<0.001. Respectively, the median time in months to hypertension control (25 th -75 th percentile) by encounter intervals was: 2.8 (1.8-3.9), 7.1 (5.1-11.3), 10.5 (8.5-14.4), 16.4 (12.4-22.6), and 23.9 (22.5-24.1) months. Young adults with 2-3 month and 3-6 month encounter intervals had higher rates of antihypertensive medication initiation within 24 months, 28% (884/3150) and 27% (850/3150) respectively, compared to 21% (661/3150) with <1 month visit interval. Conclusions: A shorter encounter interval (<1 month) is associated with higher and faster rates of hypertension control within 24 months among young adults with incident hypertension. Sustainable interventions to support shorter follow-up intervals between young adults and primary care teams are needed to improve rates and timeliness of hypertension control.
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