Dipanjan Banerjee

Journal Articles

• Insulin resistance and risk of incident heart failure: cardiovascular health study. Circulation. Heart failure Banerjee, D., Biggs, M. L., Mercer, L., Mukamal, K., Kaplan, R., Barzilay, J., Kuller, L., Kizer, J. R., Djousse, L., Tracy, R., Zieman, S., Lloyd-Jones, D., Siscovick, D., Carnethon, M. 2013; 6 (3): 364-370

  Abstract

  Background- Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance as compared with matched controls. Insulin resistance leads to structural abnormalities in the heart, such as increased left atrial size, left ventricular mass, and alterations in transmitral velocity that can precede the diagnosis of HF. It is not known whether insulin resistance precedes the development of HF or whether the relationship between insulin resistance and HF is present among adults with HF caused by nonischemic heart disease. Methods and Results- We examined 4425 participants (60% women) from the Cardiovascular Health Study after excluding those with HF, myocardial infarction, or treated diabetes mellitus at baseline. We used Cox proportional hazards models to estimate the relative risk of incident HF associated with fasting insulin measured at study entry. There were 1216 cases of incident HF (1103 without antecedent myocardial infarction) during a median follow-up of 12 years (maximum, 19 years). Fasting insulin levels were positively associated with the risk of incident HF (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15, per SD change) when adjusted for age, sex, race, field center, physical activity, smoking, alcohol intake, high-density lipoprotein-cholesterol, total cholesterol, systolic blood pressure, and waist circumference. The association between fasting insulin levels and incident HF was similar for HF without antecedent myocardial infarction (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15). Measures of left atrial size, left ventricular mass, and peak A velocity at baseline were associated both with fasting insulin levels and with HF; however, additional statistical adjustment for these parameters did not completely attenuate the insulin-HF estimate (hazard ratio, 1.08; 95% confidence interval, 1.03-1.14 per 1-SD increase in fasting insulin). Conclusions- Fasting insulin was positively associated with adverse echocardiographic features and risk of subsequent HF in Cardiovascular Health Study participants, including those without an antecedent myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.

  View details for DOI 10.1161/CIRCHEARTFAILURE.112.000022

  View details for PubMedID 23575256

• Underdiagnosis of Hypertension Using Electronic Health Records AMERICAN JOURNAL OF HYPERTENSION Banerjee, D., Chung, S., Wong, E. C., Wang, E. J., Stafford, R. S., Palaniappan, L. P. 2012; 25 (1): 97-102

  Abstract

  Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis.We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ?18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ?140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0-401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics.The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, P < 0.0001).Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority.

  View details for DOI 10.1038/ajh.2011.179

  View details for Web of Science ID 000298264800019

  View details for PubMedID 22031453

• Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients. Journal of lipids Banerjee, D., Wong, E. C., Shin, J., Fortmann, S. P., Palaniappan, L. 2011; 2011: 291954-?

  Abstract

  Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ?18?y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36?nmol/L) and NHW (29?nmol/L) had higher median Lp(a) levels than Chinese (22?nmol/L, P ? .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.

  View details for DOI 10.1155/2011/291954

  View details for PubMedID 21660301

• Right ventricular failure: a novel era of targeted therapy. Current heart failure reports Banerjee, D., Haddad, F., Zamanian, R. T., Nagendran, J. 2010; 7 (4): 202-211

  Abstract

  There now is strong evidence to recognize the pivotal role of the right ventricle (RV) in heart disease and to establish it as a unique and separate entity than the left ventricle (LV). Here, we summarize the differences between the two ventricles, the diagnosis of RV failure, and the management of acute and chronic RV failure. We review the indices derived by echocardiography used to measure RV function, and novel biomarkers that may play a role diagnosing and prognosticating in RV-specific disease. There are new novel therapies that specifically target the RV in disease. For example, phosphodiesterase type 5 inhibitors improve contractility of the hypertrophied RV while sparing the normal LV in pulmonary arterial hypertension. The metabolism of the hypertrophied RV is another area for therapeutic exploitation by metabolic modulation. We also suggest future potential molecular targets that may be unique to the RV because they are upregulated in RV hypertrophy greater than in LV hypertrophy.

  View details for DOI 10.1007/s11897-010-0031-7

  View details for PubMedID 20890792

• Lack of Improvement in Outpatient Management of Congestive Heart Failure in the United States ARCHIVES OF INTERNAL MEDICINE Banerjee, D., Stafford, R. S. 2010; 170 (15): 1399-1400

  View details for Web of Science ID 000280651500020

  View details for PubMedID 20696970

• Correlation of a [C-13]Glucose Breath Test With Surrogate Markers of Insulin Resistance in Urban and Rural Asian Indians METABOLIC SYNDROME AND RELATED DISORDERS Banerjee, D., Vikram, N., Mishra, P., Bhatt, R., Prakash, S., Misra, A. 2009; 7 (3): 215-219

  Abstract

  High rates of insulin resistance (IR), which contribute to a high prevalence of cardiovascular disease (CVD), have been noted in Asian Indians. Rapid, effective measures of IR could identify individuals at risk for CVD in this population. A [(13)C]glucose breath test has been shown to correlate significantly with invasive measures of IR in a Caucasian cohort. We hypothesized that the breath test would correlate significantly with surrogate measures of IR in Asian Indians.A total of 49 urban and 49 rural Asian Indian subjects underwent the (13)C breath test and 2-hour oral glucose tolerance testing. Correlations were performed between the breath test results and surrogate measures of IR including the homeostasis model of insulin resistance (HOMA). These two indices were also correlated with body mass index (BMI).In the overall cohort, the breath test correlated significantly with HOMA (r = -0.40; P < 0.0001), waist circumference (WC) (r = -0.70; P < 0.0001), and BMI (r = -0.59; P < 0.0001). The breath test correlated significantly with BMI in the urban and rural cohorts (r = -0.65; P < 0.0001 and r = -0.36; P = 0.01) and with HOMA (r = -0.55; P = 0.0001) in the urban cohort. There was no significant correlation between the breath test and HOMA (r = -0.07; P = 0.61) in the rural cohort. When corrected for WC and BMI, the correlation between the breath test and HOMA in the urban cohort was no longer significant (r = -0.08; P = 0.57).The (13)C breath test correlated significantly with HOMA values in urban but not in more insulin-sensitive rural subjects and yielded no incremental information over BMI. Further refinement of the [(13)C]glucose breath test is necessary prior to its use as a screening test for IR in Asian Indians.

  View details for DOI 10.1089/met.2008.0075

  View details for Web of Science ID 000266159900008

  View details for PubMedID 19284316

• Understanding and Identifying Bias and Confounding in the Medical Literature SOUTHERN MEDICAL JOURNAL Hsu, J. L., Banerjee, D., Kuschner, W. G. 2008; 101 (12): 1240-1245

  Abstract

  Bias and confounding are types of error that may be encountered in the collection, analysis, or interpretation of research data. Bias and confounding may result in erroneous research conclusions with adverse consequences for patients and health care providers. In this article, we provide clinician-friendly descriptions and examples of bias (including surveillance, information, selection, lead, length, and publication) and confounding. The purpose of the article is to help clinicians to recognize two important sources of error in research and in turn to help clinicians to assess the validity and generalizability of a research report.

  View details for Web of Science ID 000261778000015

  View details for PubMedID 19005435

• Does using ethnic specific criteria improve the usefulness of the term metabolic syndrome? controversies and suggestions INTERNATIONAL JOURNAL OF OBESITY Banerjee, D., Misra, A. 2007; 31 (9): 1340-1349

  Abstract

  The metabolic syndrome (MetS) is an important tool that identifies populations at increased risk for cardiovascular disease (CVD) and type 2 diabetes, targeting them for preventive measures. The criteria for the identification of the MetS were initially constructed from data in Caucasian populations. Recent research suggests that the current criteria for the MetS may not accurately characterize disease risk in non-Caucasian populations, either over or underestimating the risk in certain ethnic groups. Altering the criteria for each population by making ethnic-specific cutoffs as has been done with waist circumference will help in more accurate characterization. Using different combinations of the MetS criteria for different ethnic groups based CVD risk and factor analysis needs consideration. With better characterizations of patient populations, the ultimate goal would be to make MetS more accurate for predicting CVD risk while retaining the ease of screening afforded by the MetS. The proposed alterations of definition and criteria of the MetS would ensure its continued viability and sustainability.

  View details for DOI 10.1038/sj.ijo.0803619

  View details for Web of Science ID 000249090000002

  View details for PubMedID 17438559

• Principles and procedures of medical ethics case consultation BRITISH JOURNAL OF HOSPITAL MEDICINE Banerjee, D., Kuschner, W. G. 2007; 68 (3): 140-144

  Abstract

  Ethical conflicts are common in hospital medicine. This article reviews core medical ethics principles, describes models for conducting hospital-based ethics case consultations, and highlights the contributions of hospital ethics committees to high quality patient care.

  View details for Web of Science ID 000245198000005

  View details for PubMedID 17419461

• The metabolic syndrome in South Asians: Continuing escalation & possible solutions INDIAN JOURNAL OF MEDICAL RESEARCH Misra, A., Misra, R., Wijesuriya, M., Banerjee, D. 2007; 125 (3): 345-354

  Abstract

  The metabolic syndrome is a crucial factor in causation of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) in South Asians. Approximately 20-25 per cent of urban South Asians have evidence of the metabolic syndrome. Furthermore, insulin resistance was reported to be present in nearly 30 per cent of children and adolescents in India, more so in girls. At the same time many young individuals have clustering of other risk factors/conditions related to insulin resistance (e.g., non-alcoholic fatty liver disease, obstructive sleep apnoea, etc.). Rapid nutritional and lifestyle transition in urbanized areas in various countries in South Asia are prime reasons for increasing prevalence of obesity and the metabolic syndrome. It is particularly important to effectively implement and strengthen population-based primary prevention strategies for the prevention of 'epidemic' of obesity and the metabolic syndrome. The lifestyle factor modification to prevent the metabolic syndrome and T2DM in South Asians should start in early childhood. Finally, there is an urgent need to conduct research studies regarding the correct definitions of the metabolic syndrome and genetic and perinatal factors related to insulin resistance in South Asians.

  View details for Web of Science ID 000246871300012

  View details for PubMedID 17496360

• Diagnosing occupational lung disease: a practical guide to the occupational pulmonary history for the primary care practitioner. Comprehensive therapy Banerjee, D., Kuschner, W. G. 2005; 31 (1): 2-11

  Abstract

  A well-executed occupational pulmonary history should be part of the evaluation of workers presenting with respiratory illnesses or symptoms. In this article, we review the scope of occupational lung disease and detail the essential elements of the occupational pulmonary history.

  View details for PubMedID 15793319