Dr. Mamudu Publishes Article on Coronary Artery Disease in Appalachia
Dr. Hadii Mamudu, Associate Professor in the Department of Health Services Management and Policy in the ETSU College of Public Health, has published an article in the American Journal of The Medical Sciences titled Subclinical Atherosclerosis and Relationship With Risk Factors of Coronary Artery Disease in a Rural Population. Dr. Liang Wang in the Department of Biostatistics and Epidemiology; Dr. Veeranki in the Department of Preventive Medicine, an alumnus of ETSU College of Public Health, Dr. Timir Paul in the Cardiology Division of the ETSU Quillen College of Medicine, and Dr. Matthew Budoff in the Division of Cardiology in UCLA were the co-authors.
Annually, over 150,000 cardiovascular events occur among individuals aged 65 years old and younger in the United States, including asymptomatic ones. Cardiovascular diseases (CVD) is the leading cause of preventable morbidity and mortality in the United States and is highly prevalent in the rural region of central Appalachia. While cardiovascular disease accounts for about one in three deaths, coronary artery disease (CAD), the most common form of cardiovascular disease, accounts for one in six deaths in the United States. Several traditional risk factors, including hypertension, dyslipidemia, diabetes, smoking, obesity and physical inactivity, have been identified for coronary artery disease. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease, enhances risk stratification among asymptomatic individuals.
Although there has been accumulated evidence on the traditional risk factors for coronary artery disease, the prevalence and control of these risk factors continue to be a major public health burden. To deal with this problem, previous studies suggest the need to understand risk factors in specific individuals, population and region (including those in Appalachia), and to identify approaches to prevent the development of those risk factors or control them. This study is the first major study to specifically focus on a population drawn from central Appalachia. While this study adds to the limited CVD-related research pertaining to Appalachia as a whole and central Appalachia in particular, it contributes to the efforts to identify region- and population-specific strategies to prevent or reduce cardiovascular diseases in the United States and to achieve the goal of "Healthy People 2020" to reduce cardiovascular diseases in high prevalent areas and among high-risk population.
During January 2011 to December 2012, asymptomatic individuals residing in central Appalachia who voluntarily screened for coronary artery calcium at Wellmont CVA Heart Institute were enrolled into the study. Using coronary artery calcium as a marker for sub-clinical atherosclerosis and a proxy measure for coronary artery disease, authors assessed the association between coronary artery calcium and traditional risk factors and found there was significant association of mild coronary artery calcium with hypertension and family history of coronary artery disease, and moderate coronary artery calcium with smoking status. Except hypercholesterolemia and sedentary lifestyle, severe coronary artery calcium was significantly associated with major health conditions (obesity, diabetes and hypertension), lifestyle (smoking) and family history of coronary artery disease.
The association between coronary artery calcium and coronary artery disease risk factors suggests that education about subclinical atherosclerosis among asymptomatic individuals in this region with high cardiovascular disease prevalence is needed because coronary artery calcium improves coronary artery disease risk stratification, and the knowledge of coronary artery calcium enhances medication adherence and motivates individuals towards beneficial behavioral/lifestyle modification.
Dr. Mamudu oversees the Tobacco Policy Research Program at ETSU and has published extensively on issues related to global tobacco policy. The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI).