Rebecca P. Gelber

Although obesity is known to increase the risk of hypertension, few studies have prospectively evaluated body mass index (BMI) across the range of normal weight and overweight as a primary risk factor. In this prospective cohort, we evaluated the association between BMI and risk of incident hypertension. We studied 13,563 initially healthy, nonhypertensive men who participated in the Physicians' Health Study. We calculated BMI from self-reported weight and height and defined hypertension as self-reported systolic blood pressure (BP) > or = 140 mm Hg, diastolic BP > or = 90 mm Hg, or new antihypertensive medication use. After a median 14.5 years, 4920 participants developed hypertension. Higher baseline BMI, even within the "normal" range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (26.4 kg/m(2) were 1.20 (1.09-1.32), 1.31 (1.19-1.44), 1.56 (1.42-1.72), and 1.85 (1.69-2.03), respectively (P for trend, <.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. We found similar associations using other BMI categories and after excluding men with smoking history, those who developed hypertension in the first 2 years, and those with diabetes, obesity, or high cholesterol at baseline. In this large cohort, we found a strong gradient between higher BMI and increased risk of hypertension, even among men within the "normal" and mildly "overweight" BMI range. Approaches to reduce the risk of developing hypertension may include prevention of overweight and obesity.

Little is known about breast cancer management among Asian Americans and Pacific Islanders (AAPI). We performed a retrospective analysis of 2030 women (935 Japanese, 144 Chinese, 235 Filipino, 293 Hawaiian, and 423 white; mean age +/- SD, 59 +/- 13 years) with a diagnosis of early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. We linked data from the Surveillance, Epidemiology, and End Results program's Hawaii Tumor Registry to administrative health care claims. We evaluated (1) breast-conserving surgery (BCS); (2) radiotherapy after BCS; and (3) chemotherapy for node-positive disease. We used logistic regression to examine the association between AAPI ethnicity and treatment, adjusting for age, year, rural residence, tumor size, grade, nodal status, receptor status, prior cancer, comorbidity index, health plan type, and income. Overall, 60.3% of women had stage I disease, 36.8% had stage II, and 2.9% had stage IIIA. Only 55.6% received BCS, and 85.1% of these women also received radiation. Of those with nodal involvement (n = 521), 82.7% received chemotherapy. Japanese and Filipino women were significantly less likely than white women to undergo BCS (for Japanese: adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80; for Filipinos: adjusted odds ratio, 0.47; 95% confidence interval, 0.33-0.66). Filipinos tended to be less likely than white women to receive radiation after BCS (adjusted odds ratio, 0.80; 95% confidence interval, 0.42-1.49). AAPI women were as likely as white women to receive adjuvant chemotherapy for nodal spread. We found disparities in the management of early-stage breast cancer among AAPI women, particularly among Japanese and Filipinos. Further study is needed to determine the reasons for the observed disparities and to understand their effect on health outcomes.

Objective. Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic surgery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity. Design. Retrospective cohort study, 1998–2002. Setting. Tertiary care, university-affiliated hospital in Hawaii. Study participants. 1811 adults (1085 women; 743 Asians; 206 Pacific Islanders; mean age 70.6 ± 14.7 years) who underwent hip replacement, hip fracture surgery, or total knee replacement. Main outcome measures. Use of venous thromboembolism prophylaxis as recommended by the American College of Chest Physicians. Multivariable logistic regression was used to identify factors associated with prophylaxis use. Results. Overall, 49.4% of patients received venous thromboembolism prophylaxis. After adjustment for patient age, sex, thromboembolism and bleeding risk factors, type of surgery, and anesthesia, Japanese patients were less likely to receive prophylaxis [odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5–0.9; P = 0.01], whereas other ethnic groups were treated similarly to whites. Relative to patients undergoing hip replacement, those with hip fracture surgery were less likely (OR = 0.4; 95% CI = 0.3–0.5; P < 0.01), and those receiving total knee replacement more likely (OR = 4.5; 95% CI = 3.6–5.7; P < 0.01) to receive appropriate prophylaxis. Conclusion. Despite consensus recommendations, venous thromboembolism prophylaxis use among high-risk patients remains low. Japanese patients and those undergoing hip fracture surgery are at particular risk for not receiving appropriate prophylaxis in our population. Further research is needed to clarify the reasons for our findings and to determine if this variation is associated with increased risk of thromboembolic complications.

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