scholarly journals The nature of COPD revealed by self-tracking, PRO-data and analysis of contact pattern for participants in a personalized health centered living lab organized according to the Epital Care Model. A longitudinal study. (Preprint)

2020 ◽  
Author(s):  
Klaus Phanareth ◽  
Astrid Laura Dam ◽  
Martin ABC Hansen ◽  
Signe Lindskrog ◽  
Søren Vingtoft ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pulmonary Function ◽  
Oxygen Saturation ◽  
Healthcare Professionals ◽  
Factor Group ◽  
Chronic Obstructive ◽  
Care Model ◽  
Copd Patients ◽  
Group A ◽  
Group D

BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate and temperature with synchronous communication of health data may become a powerful solution as they enable healthcare professionals to react with a pro-active and adequate response. We have taken this idea to the next level in the Epital Care Model (ECM) and organized a person-centered technology assisted ecosystem to provide health services to COPD patients. OBJECTIVE The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on PRO data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know: 1) What is the incidence of mild, moderate and severe exacerbations in a mixed population of COPD patients? 2) What is the course of the mild, moderate and severe exacerbations? And 3) How is the activity and pattern of contacts to health professionals related to the participants condition? METHODS Convenience sampling during the period November 2013 to December 2015. The participants’ sex, age, FEV1, pulse rate and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering four questions and sending three semi-automated measurements. RESULTS Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C and 39 in D. The number of observed days was 31801 days with 12470 measurements and 1397 care notes and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D have the highest number of hospitalizations (16), exacerbations (151), and contacts (1910) The initial contacts during the first month declined within three months to 1/3 for care contacts and 1/2 for treatment contacts and reached a plateau after four months. CONCLUSIONS The majority of COPD patients in risk factor group D can be managed virtually and only 13% of those with severe exacerbations required hospitalization. Contact to the healthcare professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings.

scholarly journals The characteristics of airflow obstruction and its association with treatment response in the real world in different GOLD groups of COPD patients

2021 ◽  
Author(s):  
Qing Song ◽  
Yi-Yang Zhao ◽  
Yu-Qin Zeng ◽  
Cong Liu ◽  
Wei Cheng ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Pulmonary Function ◽  
Treatment Response ◽  
Real World ◽  
Airflow Obstruction ◽  
Chronic Obstructive ◽  
The Real ◽  
Copd Patients ◽  
Long Acting ◽  
Group D

Abstract Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 separated spirometry from combined assessment to guide treatment. We aimed to analyze the characteristics of airflow obstruction and its association with treatment response in the real world in different GOLD groups of COPD patients. Methods: For this prospective observational study, stable COPD outpatients were enrolled and divided into Groups A, B, C and D based on GOLD 2017, and followed-up for 18 months. Data on patient demographics, pulmonary function, COPD assessment test (CAT), Clinical COPD Questionnaire (CCQ), modified Medical Research Council (mMRC), exacerbations, mortality and treatments were collected to analyze the airflow obstruction and its association with treatment response. Results: A total of 993 subjects were classified into Groups A (n = 170, 17.1%), B (n = 360, 36.3%), C (n = 122, 12.3%), and D (n = 341, 34.3%). There were significant differences in mMRC, CAT, CCQ, exacerbations and hospitalizations among different groups (P < 0.001). Groups B and D had more airflow obstruction and ventilatory disorder than Groups A and C (P < 0.05). In the same groups with different GOLD grades, the differences were mainly observed in BMI, CAT, CCQ and treatment with long-acting muscarinic antagonist (LAMA) and LAMA + long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS) (P < 0.05). After 18 months of follow-up, the number of exacerbations and hospitalizations were significantly different among different groups, with Group D having the highest values. Also, there were more frequent exacerbators and a higher mortality rate in Group D. However, in the same groups with different GOLD grades, the mortality rates and number of exacerbations, hospitalizations and frequent exacerbators showed no differences. Conclusion: There were significant differences in pulmonary function in different groups. However, different GOLD grades had no impact on future exacerbations and mortality rate in the same groups.

Biofeedback flutter device for managing the symptoms of patients with COPD

2020 ◽  
Vol 28 (5) ◽  
pp. 477-485
Author(s):  
Rekha Kaja ◽  
Anandh Vaiyapuri ◽  
Mohamed Sherif Sirajudeen ◽  
Hariraja Muthusamy ◽  
Radhakrishnan Unnikrishnan ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Chronic Obstructive ◽  
Post Intervention ◽  
Oxygen Saturation Level ◽  
Chronic Obstructive Pulmonary Diseases ◽  
Before And After ◽  
Group A ◽  
Dyspnea Score ◽  
Group B ◽  
Group D

BACKGROUND: Flutter is a device used in removing excess lung secretions. The conventional flutter lacks a biofeedback component to facilitate optimal use by the patients. OBJECTIVE: The current research aims to compare the effects of biofeedback flutter devices with the conventional flutter in managing the symptoms of patients with chronic obstructive pulmonary diseases. METHODS: One hundred and sixty-eight participants were randomly allocated into four groups: Group A (conventional), Group B (visual biofeedback), Group C (auditory biofeedback) and Group D (visual and auditory biofeedback). All groups were treated five days for 20 minutes. Outcome measures included wet sputum weight [during intervention (T1) and 1 hour after intervention (T2)], oxygen saturation and dyspnea score (before and after intervention) on all days. RESULTS: The wet sputum expectorated (T2) by Group B was significantly higher than Group A (P< 0.001), Group C (P< 0.001) and Group D (P< 0.05). The dyspnea score for Group B (P< 0.05), Group C (P< 0.05) and Group D (P< 0.05) was significantly lower than Group A. The post-intervention oxygen saturation level was higher in Group D followed by Groups B, C and A. CONCLUSION: The use of biofeedback flutter is effective in the removal of secretion, reducing dyspnea and improving oxygen saturation when compared to conventional flutter.

Anxiety and Depression among Patients with Chronic Obstructive Pulmonary Diseases in Pulmonology Unit of Nobel Medical College Teaching Hospital

2021 ◽  
Vol 6 (1) ◽  
pp. 1285-1290
Author(s):  
Nilam Kumari Jha ◽  
Komal Kant Jha
Keyword(s):  
Risk Factor ◽  
Teaching Hospital ◽  
College Teaching ◽  
Pulmonary Diseases ◽  
Anxiety And Depression ◽  
Chronic Obstructive ◽  
Early Assessment ◽  
Medical College ◽  
Copd Patients ◽  
Chronic Obstructive Pulmonary Diseases

Introduction: Anxiety and Depression is a common comorbidity in chronic obstructive pulmonary disease patients. Impaired lung function is a risk factor for depression In COPD patients, reduced recreational activities and social Isolation is a major risk factor resulting in anxiety and depression.  Objective: The objective of this study is to evaluate the prevalence of Anxiety and Depression among the COPD patients at Pulmonology unit of Nobel Medical College Teaching Hospital.  Methodology: A hospital based cross- sectional research design was used for the study. A total of 185 patients with previously diagnosed COPD. Data were collected by using a face to face interview technique in patients to evaluate anxiety and depression using Nepali version of Hospital Anxiety and Depression Scale questionnaire at Nobel Medical College Teaching Hospital, Biratnagar, Nepal from May to August 2020. Data analysis were done by descriptive and inferential statistics.  Results: A total of 185 patients participated in the study, 157 patients (84.9%) had anxiety, 107 patients (57.8%) had depression and 102 patients (55.1%) had both anxiety and depression. There was statistically significant association of anxiety and depression in COPD patients with age, religion, occupation, smoking status, duration of illness, history of previous hospitalization, number of hospitalization in previous year, type of family, domiciliary oxygen therapy.  Conclusion: The study concluded that anxiety and depression had been most prevalent in COPD patients. Therefore health personnel working in the Pulmonology unit should be aware the early assessment and treatment of anxiety and depression of chronic obstructive pulmonary diseases patients. 

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND COMORBIDITIES: MANAGEMENT OF SOMATOFORM DISORDERS

2021 ◽  
Vol 74 (6) ◽  
pp. 1401-1404
Author(s):  
Liliia V. Burya ◽  
Anna A. Kapustianska ◽  
Nataliia V. Moiseieva ◽  
Andrii V. Vakhnenko ◽  
Mariia O. Rumiantseva ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Somatoform Disorders ◽  
Comprehensive Evaluation ◽  
Pulmonary Ventilation ◽  
Multidisciplinary Care ◽  
Step Test ◽  
Chronic Obstructive ◽  
Copd Exacerbations ◽  
Group D ◽  
Severe Copd

The aim: To perform a comprehensive evaluation of the effect of paroxetine on the degree of somatoform disorders in exacerbation of severe COPD in women. Materials and methods: The study involved 53 female patients with severe COPD (Group D), confirmed by instrumental methods of study. At hospitalization, patients were divided into 2 groups. Patients of Group 1 (n = 21; aged 52.5 ± 0.8 years old) underwent basic exacerbation therapy. Patients of Group 2 (n = 22; aged 57.9 ± 0.4 years old) underwent basic exacerbation therapy supplemented with paroxetine for 14 days, 1 tablet (0.20 g) once a day. Results: The basic therapy for treatment of COPD exacerbations, supplemented with paroxetine, led to a positive clinical effect, confirmed by increase in skeletal and respiratory muscular system, increased parameters of pulmonary ventilation, increased tolerance to physical load, increased oxygen saturation, decreased heart rate and breathing rate. Conclusions: The strategy for choosing an antidepressant to provide multidisciplinary care for somatoform disorders in women with exacerbation of severe COPD (group D) should take into account the efficacy and favorable safety profile and personalization of the drug. In exacerbation of severe COPD, the degree of somatoform disorders in patients correlates with the severity of the main criteria: FVC1, the distance walked during the 6-minute step test, oxygen saturation after the 6-minute step test, end-expiratory pressure in the oral cavity.

scholarly journals Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease

2010 ◽  
Vol 67 (1) ◽  
pp. 36-41
Author(s):  
Ivan Cekerevac ◽  
Zorica Lazic ◽  
Ljiljana Novkovic ◽  
Marina Petrovic ◽  
Vojislav Cupurdija ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Function ◽  
Exercise Tolerance ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Diffusion Capacity ◽  
Tolerance Level ◽  
Lung Hyperinflation ◽  
Copd Patients

Background/Aim. Peripheral muscle weakness and nutritional disorders, firstly loss of body weight, are common findings in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the impact of pulmonary function parameters, nutritional status and state of peripheral skeletal muscles on exercise tolerance and development of dyspnea in COPD patients. Methods. Thirty COPD patients in stable state of disease were analyzed. Standard pulmonary function tests, including spirometry, body pletysmography, and measurements of diffusion capacity were performed. The 6-minute walking distance test (6MWD) was done in order to assess exercise tolerance. Level of dyspnea was measured with Borg scale. In all patients midthigh muscle cross-sectional area (MTCSA) was measured by computerized tomography scan. Nutritional status of patients was estimated according to body mass index (BMI). Results. Statistically significant correlations were found between parameters of pulmonary function and exercise tolerance. Level of airflow limitation and lung hyperinflation had significant impact on development of dyspnea at rest and especially after exercise. Significant positive correlation was found between MTCSA and exercise tolerance. Patients with more severe airflow limitation, lung hyperinflation and reduced diffusion capacity had significantly lower MTCSA. Conclusion. Exercise tolerance in COPD patients depends on severity of bronchoobstruction, lung hyperinflation and MTCSA. Severity of bronchoobstruction and lung hyperinflation have significant impact on dyspnea level.

scholarly journals Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emanuela Zannin ◽  
Ilaria Milesi ◽  
Roberto Porta ◽  
Simona Cacciatore ◽  
Luca Barbano ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Work Of Breathing ◽  
Lung Mechanics ◽  
Intrinsic Peep ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Ineffective Efforts ◽  
Expiratory Flow

Abstract Background Tidal expiratory flow limitation (EFLT) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFLT. Methods This prospective, cross-over, open-label study randomized patients to one night of fixed-EPAP and one night of EFLT-abolishing-EPAP. The primary outcome was transcutaneous carbon dioxide pressure (PtcCO2). Secondary outcomes were: peripheral oxygen saturation (SpO2), frequency of ineffective efforts, breathing patterns and oscillatory mechanics. Results We screened 36 patients and included 12 in the analysis (age 72 ± 8 years, FEV1 38 ± 14%Pred). The median EPAP did not differ between the EFLT-abolishing-EPAP and the fixed-EPAP night (median (IQR) = 7.0 (6.0, 8.8) cmH2O during night vs 7.5 (6.5, 10.5) cmH2O, p = 0.365). We found no differences in mean PtcCO2 (44.9 (41.6, 57.2) mmHg vs 54.5 (51.1, 59.0), p = 0.365), the percentage of night time with PtcCO2 > 45 mm Hg was lower (62(8,100)% vs 98(94,100)%, p = 0.031) and ineffective efforts were fewer (126(93,205) vs 261(205,351) events/hour, p = 0.003) during the EFLT-abolishing-EPAP than during the fixed-EPAP night. We found no differences in oxygen saturation and lung mechanics between nights. Conclusion An adaptive ventilation mode targeted to abolish EFLT has the potential to reduce hypercapnia and ineffective efforts in stable COPD patients receiving nocturnal NIV. Trial registration: ClicalTrials.gov, NCT04497090. Registered 29 July 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04497090.

scholarly journals Krónikus légzőszervi betegek tápláltsági állapotának vizsgálata – klinikai megfigyelések

2019 ◽  
Vol 160 (23) ◽  
pp. 908-913
Author(s):  
Mónika Fekete ◽  
Vince Pongor ◽  
Ágnes Fehér ◽  
Márta Veresné Bálint ◽  
János Tamás Varga ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Pulmonary Function ◽  
Respiratory Muscles ◽  
Prognostic Indicator ◽  
Chronic Obstructive ◽  
Forced Expiration ◽  
Record System ◽  
Severity Of Disease ◽  
Copd Patients ◽  
System Inclusion

Abstract: Introduction: The increased metabolism of nutrients and the low energy intake may lead to malnutrition among chronic obstructive pulmonary disease (COPD) patients. Aim: The goal of our study was to examine the nutritional status of our population aged over 40, and its relationship with the severity of the disease. Method: We conducted a retrospective study at the National Korányi Institute of Pulmonology in 2017. Pulmonary function and anthropometric data were obtained from the electronic health record system. Inclusion criteria were age over 40 and the diagnosis of COPD. Severity of disease was assessed by forced expiration volume and categorized according to GOLD stages. We used SPSS Statistics V22.0 for data analysis. Results: The mean age of participants was 66; 49.3% were men, 50.7% were women. Average BMI was 27.14 kg/m², with values comprising cachexia and severe obesity. According to the FEV1%pred results of the 3236 patients, 30% fell in the GOLD I, 40% in the GOLD II, 23% in the GOLD III, and 7% in the GOLD IV categories. Pearson coefficient found positive correlation between FEV1 and nutritional status (H = 0.2297, r = 0.1401), specifically between severity of cachexia and severity of disease. The analysis of variance showed significant correlation between severity of disease and nutritional status; patients with higher BMI had better pulmonary function. Conclusion: Malnutrition had an adverse effect on pulmonary functions and performance of respiratory muscles, whereas higher BMI had a positive effect on FEV1. Our results suggest that BMI could be used as a lung function prognostic indicator for COPD patients. Orv Hetil. 2019; 160(23): 908–913.

scholarly journals Correlates of variability in endurance shuttle walk test time in patients with chronic obstructive pulmonary disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249786
Author(s):  
Anouk A. F. Stoffels ◽  
Bram van den Borst ◽  
Jeannette B. Peters ◽  
Mariska P. M. Klaassen ◽  
Hanneke A. C. van Helvoort ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Function ◽  
Pulmonary Disease ◽  
Performance Measures ◽  
Exercise Tolerance ◽  
Chronic Obstructive ◽  
Walk Test ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Background The endurance shuttle walk test (ESWT) is used to evaluate exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). The recommended pre-intervention tolerated duration (Tlim) is between 3–8 minutes for optimal interpretation of treatment effects. However, this window may be exceeded and factors determining ESWT Tlim are not completely understood. Therefore, we aimed to determine whether pulmonary function, physical and incremental shuttle walk test (ISWT) performance measures are associated with ESWT Tlim in COPD patients. Methods Assessment data from patients eligible for pulmonary rehabilitation was retrospectively analyzed. Inclusion criteria were: diagnosis of COPD and complete data availability regarding ESWT and ISWT. Patients performed an ESWT at 85% of ISWT speed and were divided into three groups (ESWT Tlim: <3 minutes, 3–8 minutes, >8 minutes). Subject characteristics, severity of complaints, pulmonary function, physical capacity and activity, exercise tolerance and quadriceps muscle strength were evaluated. Results 245 COPD patients (FEV1 38 (29–52)% predicted) were included. Median ESWT Tlim was 6.0 (3.7–10.3) minutes, 41 (17%) patients walked <3 minutes and 80 (33%) patients walked >8 minutes. Body mass index, maximal oxygen consumption, Tlim on constant work rate cycle test, physical activity level, maximal ISWT speed, dyspnoea Borg score at rest and increase of leg fatigue Borg score during ISWT independently predicted Tlim in multivariate regression analysis (R2 = 0.297, p<0.001). Conclusion This study reported a large variability in ESWT Tlim in COPD patients. Secondly, these results demonstrated that next to maximal ISWT speed, other ISWT performance measures as well as clinical measures of pulmonary function, physical capacity and physical activity were independent determinants of ESWT Tlim. Nevertheless, as these determinants only explained ~30% of the variability, future studies are needed to establish whether additional factors can be used to better adjust individual ESWT pace in order to reduce ESWT Tlim variability.

scholarly journals Palliative care integration for patients with advanced chronic obstructive pulmonary disease (COPD): Identifying essential components using participatory action research

2021 ◽  
pp. 026921632110289
Author(s):  
Tanja Fusi-Schmidhauser ◽  
Katherine Froggatt ◽  
Nancy Preston
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Care Model ◽  
Participatory Action ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in standard care remains underdeveloped. The unpredictability of the disease progression and misconceptions about palliative care being equivalent to end-of-life care often prevent a timely integrated approach in advanced COPD. Aim: To identify practices designed to increase integration of palliative care in the management of patients with advanced COPD in a respiratory service in Southern Switzerland. Design: A participatory action research approach was chosen and key stakeholders were involved to develop new knowledge and practices, supported by a Theory of Change framework. Data from each cycle and retrospective analysis at the end of the whole research were analysed using thematic analysis. Setting/participants: Five action research cycles with seven healthcare professionals working in palliative or respiratory care settings were conducted. Results: Three elements of integrated palliative care in advanced COPD were identified: multidimensional assessment, healthcare professionals’ education and interdisciplinary team meetings, which are the pillars of a new integrated palliative care model for patients with advanced COPD. Conclusions: The new integrated palliative care model in advanced COPD includes essential elements with a focus on patients, healthcare professionals and care delivery. Further research on testing this model in clinical practice, service development, implementation processes and possible outcomes, including evaluation of the financial impact of integrated palliative care is necessary to foster this care approach across all possible settings.

Abstract WP229: Young African Americans With Stroke Have a Greater Burden of Multiple Risk Factors Than Their White Counterparts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Prachi Mehndiratta ◽  
Kathleen Ryan ◽  
John W Cole ◽  
Marcella Wozniak ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Logistic Regression ◽  
Risk Factor ◽  
Vascular Risk Factors ◽  
Factor Group ◽  
Vascular Risk ◽  
Multiple Risk Factors ◽  
Multiple Risk ◽  
Group D

Background: Stroke in young adults accounts for 15-18% of all ischemic stroke (IS) cases and disproportionately affects African Americans (AfrAm). While it is well known that a higher prevalence of vascular risk factors, particularly HTN and DM, contributes to this excess risk, few studies have examined the potential contribution of the synergistic risk from multiple vascular risk factors. Methods: A population-based case-control study with 582 cases and 727 controls ages 15-49 was used to investigate the relationship of multiple risk factors and IS in young adults and compare AfrAM and White cases for the prevalence of multiple risk factors. Logistic regression analysis with adjustment for age, sex, and race was used to evaluate the association between the following mutually exclusive risk factor groups and IS: (a) Smoking alone, (b) Smoking+ HTN only, (c) Smoking + HTN +Obesity only (d) Smoking + HTN + Obesity +DM. The reference group for these analyses was those with no risk factors. Logistic regression with adjustment for age only was also used to compare AfrAM vs White cases for their prevalence in each risk factor group. Results: There were a total 218 cases with no risk factors. The odds of having an IS increased exponentially as the number of risk factors increased (OR 2.3, 95% CI 1.8 - 3.0, p <0.0001 for group a versus OR 16.5, 95% CI 4.8-56.1, p<0.0001 for group d). Young AfrAM cases were approximately 6 times more likely (25.3% vs. 4.3% p<0.0001) than White cases to be in the multiple risk factor group d. Conclusion: The risk of IS increases in an exponential manner in young adults with an increasing number of traditional risk factors. Compared to their White counterparts, young AfrAm IS cases are approximately 6 times more likely to have all 4 risk factors: smoking, HTN, DM and obesity. Risk factor synergy could contribute to the excess risk of IS among young AfrAm and our study emphasizes early screening for vascular risk factors in this subgroup.

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