0
Vascular Disease and the Hispanic Population:
Major disparity in the US
Heron E. Rodriguez MD
Hispanics in the US Population
15%
Hispanics in the US Population
15% 30%
Health Disparities among Hispanics
• Diabetes
• Renal failure
• Risk of death from
prostate cancer and
liver disease.
1) Carotid artery / Stroke
2) Abdominal Aortic Aneurysm
3) Lower Extremity Occlusive Disease
Carotid Artery Disease
• 795,000 strokes each year in the US
– One stroke every 40 seconds
– 3rd leading cause of death
• ...
Embolization
Ruptured
Fibrous Cap
Athero- and
Thromboemboli
Large Lipid Core Stroke or CVA
Carotid Artery Disease
Carotid Artery Disease
Smoking cessation
Antiplatelet Therapy
– Aspirin
– Clopidogrel
(Plavix)
Blood Pressure
Control
Statins
Carotid Artery Dise...
Carotid Endarterectomy
Carotid Endarterectomy
CAS
Carotid Artery Disease
Devastating consequences
Preventable
Easily detected
Treated by very effective interventions
Carotid Artery Disease
Morrissey et al
JVS 2007
2000 2001 2002 2003 2004
White
Hispanic
More frequently presented with
sym...
Carotid Artery Disease
• Hispanics present at more advanced
stages
• Underutilize carotid revascularization
• Have worse p...
Abdominal Aortic Aneurysm
Affects 5% white elderly
males
If untreated, 90% mortality
Abdominal Aortic Aneurysm
2007 SAAAVE Act: allows for
US screening in elderly smokers
and family history
Abdominal Aortic Aneurysm
2007 SAAAVE Act: allows for
US screening in elderly smokers
and family history
Abdominal Aortic Aneurysm
2007 SAAAVE Act: allows for
US screening in elderly smokers
and family history
Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
Devastating, fatal consequences
Easily detected
Treated by very effective interventions
Abdominal Aortic Aneurysm
Prevalence in Hispanics is unknown
2000 2001 2002 2003 2004
White
Hispanic
More frequently prese...
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2...
Abdominal Aortic Aneurysm
Vogel et al. Vascular and Endovascular Surgery 2009
6227 patients hospitalized in new
Jersey fro...
Abdominal Aortic Aneurysm
Vogel et al. Vascular and Endovascular Surgery 2009
6227 patients hospitalized in new
Jersey fro...
Abdominal Aortic Aneurysm
Vogel et al, Vascular and Endovascular Surgery 2009
Abdominal Aortic Aneurysm
• Prevalence in Hispanics is not known
• Present more frequently with rupture
• Underutilize ope...
Lower Extremity Occlusive Disease
Lower Extremity Occlusive Disease
Morrissey et al
JVS 2007
Lower Extremity Occlusive Disease
Morrissey et al
JVS 2007
Lower Extremity Occlusive Disease
Robinson et al
JVS 2009
Lower Extremity Occlusive Disease
Lower Extremity Occlusive Disease
Rowe et al, Vascular and Endovascular Surgery 2007
Lower Extremity Occlusive Disease
Rowe et al, Vascular and Endovascular Surgery 2007
Vascular Diseases in Hispanics
• Increased prevalence
• Presents at more advanced stages
• Patients have worse outcomes
Wh...
• 28128 patients undergoing bypass
surgery in CA
• Follow-up 61.5 months
Vascular Diseases in Hispanics
• Higher prevalence of gangrene at initial
surgery
– 36.7% vs 19.3% in whites
• Higher comorbidity index
– 22.1% vs 14.8% ...
Lower Extremity Occlusive Disease
Feinglass et al
JVS 2010
Vascular Surgery Disparity
• Controlling for age and baseline factors
(gangrene, comorbidities)
• BETTER PERIOPERATIVE AND...
Vascular Surgery Disparity
Different genetic makeup
• A strong reason for the observed disparity
is the fact that Hispanic...
Risk Factors
• Diabetes
• Renal Failure
• HTN
• ETOH use
• Smoking• Hyper-
lipidemia
• Obesity
Vascular Surgery Disparity
• Access to care
• Health literacy
• Cultural isolation
• Language issues
Vascular Surgery Disparity
• Access to care
• Health literacy
• Cultural isolation
• Language issues
• Shortage of Vascula...
Vascular Surgery Disparity
• Overall, there is a lack of Vascular
Surgeons
– 2610 Vascular Surgeons
– 1 per 121,600 people
Practicing
physicians
in the US
Hispanic
physicians
in the US
Hispanic
physicians
in the US
Only 3% of
SVS
members
Hispanic
trainees
in the US
KANE et al
JVS 2009
Conclusions
• Significant disparities affect the Hispanic
population of the US regarding vascular
disease
• The causes are...
Conclusions
• Urgent need to increase resources
– The study of disparity
– Recruitment of individuals of Hispanic
origin i...
Training Opportunities
• ACGME approved new training paradigms that
lead to certification.
– 5+2: Currently, most fellowsh...
Student Networking Section
• Join the SVS Student Networking Section to
receive direct access to valuable career
resources...
Podcasts on iTunes
• The Educational Topics on Vascular Surgery for
Medical Students and Residents
Podcasts address a broa...
• Student and resident e-newsletter,
On the Cutting Edge, reports on new
training programs, research and award
opportuniti...
Find A Mentor
• Search the online SVS Mentor Match-
up for a mentor. SVS members are
happy to discuss your career and serv...
2010 Vascular Annual Meeting
• Attend the 2010 Vascular Annual Meeting,
June 10-14 in Boston to learn more about a
career ...
• www.VascularWeb.org provides
information for students on training
programs, vascular surgery images and
information for ...
Need More Information?
Society for Vascular Surgery
633 N. St. Clair, 24th
Floor
Chicago, IL 60611
Phone: 800-258-7188 or ...
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Power Point Slides - PowerPoint Presentation
Power Point Slides - PowerPoint Presentation
Power Point Slides - PowerPoint Presentation
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  • Distal microembolization occurs spontaneously in acute coronary syndromes. When the fibrous cap of a vulnerable plaque ruptures a portion of the large lipid core is released as atheroemboli. The remaining plaque core contains tissue factor, which is highly thrombogenic, leading to thrombus formation overlying the lesion. Platelets and thrombus may also embolize. This process is likely to be ongoing, whereby a plaque ruptures and then heals and ruptures again, leading to a progression of CAD and unstable angina, or if the emboli are occlusive – acute MI.
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    1. 1. Vascular Disease and the Hispanic Population: Major disparity in the US Heron E. Rodriguez MD
    2. 2. Hispanics in the US Population 15%
    3. 3. Hispanics in the US Population 15% 30%
    4. 4. Health Disparities among Hispanics • Diabetes • Renal failure • Risk of death from prostate cancer and liver disease.
    5. 5. 1) Carotid artery / Stroke 2) Abdominal Aortic Aneurysm 3) Lower Extremity Occlusive Disease
    6. 6. Carotid Artery Disease • 795,000 strokes each year in the US – One stroke every 40 seconds – 3rd leading cause of death • Leading cause of disability – over 3 million survivors - many disabled • Cost of Stroke: $68.9 billion – Lifetime cost $140,048
    7. 7. Embolization Ruptured Fibrous Cap Athero- and Thromboemboli Large Lipid Core Stroke or CVA Carotid Artery Disease
    8. 8. Carotid Artery Disease
    9. 9. Smoking cessation Antiplatelet Therapy – Aspirin – Clopidogrel (Plavix) Blood Pressure Control Statins Carotid Artery Disease: Prevention
    10. 10. Carotid Endarterectomy
    11. 11. Carotid Endarterectomy
    12. 12. CAS
    13. 13. Carotid Artery Disease Devastating consequences Preventable Easily detected Treated by very effective interventions
    14. 14. Carotid Artery Disease Morrissey et al JVS 2007 2000 2001 2002 2003 2004 White Hispanic More frequently presented with symptomatic disease Higher perioperative stroke rate
    15. 15. Carotid Artery Disease • Hispanics present at more advanced stages • Underutilize carotid revascularization • Have worse perioperative outcomes
    16. 16. Abdominal Aortic Aneurysm Affects 5% white elderly males If untreated, 90% mortality
    17. 17. Abdominal Aortic Aneurysm 2007 SAAAVE Act: allows for US screening in elderly smokers and family history
    18. 18. Abdominal Aortic Aneurysm 2007 SAAAVE Act: allows for US screening in elderly smokers and family history
    19. 19. Abdominal Aortic Aneurysm 2007 SAAAVE Act: allows for US screening in elderly smokers and family history
    20. 20. Abdominal Aortic Aneurysm
    21. 21. Abdominal Aortic Aneurysm Devastating, fatal consequences Easily detected Treated by very effective interventions
    22. 22. Abdominal Aortic Aneurysm Prevalence in Hispanics is unknown 2000 2001 2002 2003 2004 White Hispanic More frequently presented with rupture Almost double the perioperative mortality rate Morrissey et al JVS 2007
    23. 23. 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 EVAR OPEN Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States.
    24. 24. Abdominal Aortic Aneurysm Vogel et al. Vascular and Endovascular Surgery 2009 6227 patients hospitalized in new Jersey from 2001-2006 for AAA treatment.
    25. 25. Abdominal Aortic Aneurysm Vogel et al. Vascular and Endovascular Surgery 2009 6227 patients hospitalized in new Jersey from 2001-2006 for AAA treatment. EVAR 256 cases in 2001 (24%) 775 cases in 2006 (73%)
    26. 26. Abdominal Aortic Aneurysm Vogel et al, Vascular and Endovascular Surgery 2009
    27. 27. Abdominal Aortic Aneurysm • Prevalence in Hispanics is not known • Present more frequently with rupture • Underutilize open and endovascular repair • Have worse perioperative outcomes
    28. 28. Lower Extremity Occlusive Disease
    29. 29. Lower Extremity Occlusive Disease
    30. 30. Morrissey et al JVS 2007 Lower Extremity Occlusive Disease
    31. 31. Morrissey et al JVS 2007 Lower Extremity Occlusive Disease
    32. 32. Robinson et al JVS 2009 Lower Extremity Occlusive Disease
    33. 33. Lower Extremity Occlusive Disease Rowe et al, Vascular and Endovascular Surgery 2007
    34. 34. Lower Extremity Occlusive Disease Rowe et al, Vascular and Endovascular Surgery 2007
    35. 35. Vascular Diseases in Hispanics • Increased prevalence • Presents at more advanced stages • Patients have worse outcomes Why? Different genetic makeup? Increased frequency of risk factors?
    36. 36. • 28128 patients undergoing bypass surgery in CA • Follow-up 61.5 months Vascular Diseases in Hispanics
    37. 37. • Higher prevalence of gangrene at initial surgery – 36.7% vs 19.3% in whites • Higher comorbidity index – 22.1% vs 14.8% in whites • Limb salvage rate at 3 yrs – 75% vs 90% in whites Vascular Diseases in Hispanics
    38. 38. Lower Extremity Occlusive Disease Feinglass et al JVS 2010
    39. 39. Vascular Surgery Disparity • Controlling for age and baseline factors (gangrene, comorbidities) • BETTER PERIOPERATIVE AND ESSENTIALLY IDENTICAL AMPUTATION FREE SURVIVAL OUTCOMES
    40. 40. Vascular Surgery Disparity Different genetic makeup • A strong reason for the observed disparity is the fact that Hispanic patients present at later stages with worse comorbidities
    41. 41. Risk Factors • Diabetes • Renal Failure • HTN • ETOH use • Smoking• Hyper- lipidemia • Obesity
    42. 42. Vascular Surgery Disparity • Access to care • Health literacy • Cultural isolation • Language issues
    43. 43. Vascular Surgery Disparity • Access to care • Health literacy • Cultural isolation • Language issues • Shortage of Vascular Surgeons • Shortage of Hispanic Vascular Surgeons
    44. 44. Vascular Surgery Disparity • Overall, there is a lack of Vascular Surgeons – 2610 Vascular Surgeons – 1 per 121,600 people
    45. 45. Practicing physicians in the US
    46. 46. Hispanic physicians in the US
    47. 47. Hispanic physicians in the US Only 3% of SVS members
    48. 48. Hispanic trainees in the US
    49. 49. KANE et al JVS 2009
    50. 50. Conclusions • Significant disparities affect the Hispanic population of the US regarding vascular disease • The causes are multifactorial • Access to care and other consequences of poverty appears to be a major determinant
    51. 51. Conclusions • Urgent need to increase resources – The study of disparity – Recruitment of individuals of Hispanic origin into medical schools, surgical programs and Vascular surgery training – Recruitment of practicioners of Hispanic origin
    52. 52. Training Opportunities • ACGME approved new training paradigms that lead to certification. – 5+2: Currently, most fellowships consist of two years of vascular training after completing an ACGME- approved GS residency (two Boards). – 4+2: Also available is the fast track, which is a total of six years (two Boards). – 0+5: Integrated program of which 3 years are devoted to vascular surgery and 2 years to core surgical training (one Board in VS). – 3+3: Consists of 3 years vascular surgery training following 3 initial years of preliminary general surgery training in the same institution (one Board in VS).
    53. 53. Student Networking Section • Join the SVS Student Networking Section to receive direct access to valuable career resources, as well as network with similarly interested students. • Benefits include items such as various SVS e- communications and e-newsletters, access to the online edition of Vascular Specialist and monthly podcasts on vascular surgery topics.
    54. 54. Podcasts on iTunes • The Educational Topics on Vascular Surgery for Medical Students and Residents Podcasts address a broad scope of vascular surgery topics, as well as career opportunities. • New podcasts are posted monthly on iTunes. Subscribe through iTunes (Medical Podcasts) or VascularWeb.org.
    55. 55. • Student and resident e-newsletter, On the Cutting Edge, reports on new training programs, research and award opportunities, and breaking vascular research. • Sign-up by sending email to studentresident@vascularsociety.org Student and Resident E-newsletter
    56. 56. Find A Mentor • Search the online SVS Mentor Match- up for a mentor. SVS members are happy to discuss your career and serve as a mentor. • You can search for mentors based on location and gender at www.VascularWeb.org.
    57. 57. 2010 Vascular Annual Meeting • Attend the 2010 Vascular Annual Meeting, June 10-14 in Boston to learn more about a career in vascular surgery. There is no registration fee for students. • Ask a SVS member at your institution to nominate you for a student travel scholarship. Nomination forms are online at VascularWeb.org.
    58. 58. • www.VascularWeb.org provides information for students on training programs, vascular surgery images and information for papers, and breaking vascular research. Additional Online Resources
    59. 59. Need More Information? Society for Vascular Surgery 633 N. St. Clair, 24th Floor Chicago, IL 60611 Phone: 800-258-7188 or 312-334-2300 Fax: 312-334-232- Email: studentresident@vascularsociety.org www.VascularWeb.org Herodrig@nmh.org
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