Results: Overall, an association of cognitive impairment and statin use was observed (8.6% of users vs 7.7% of nonusers had cognitive impairment, P = 0.014); but, after adjusting for variables known to be associated with cognition (age, gender, race, income, education level, and cardiovascular disease), the association was attenuated (odds ratio [OR]: 0.98, confidence interval [CI]: 0.87-1.10). No association was observed between statin type (lipophilic vs hydrophilic) and cognition (OR: 1.03, CI: 0.86-1.24), and there were no regional differences in cognitive impairment in statin users (8% in the Stroke Belt and 7.9% in other regions, P = 0.63). Conclusions: Statin use and type were marginally associated with cognitive impairment. After adjusting for known variables that affect cognition, no association was observed. No regional differences were observed. This large study found no evidence to support an association between statins and cognitive performance. IntroductionCognitive impairment and decrements over time are associated with cardiovascular diseases such as hypertension and diabetes and with cerebrovascular changes such as

Purpose Medications can have unintended effects. High medication use populations may benefit from increased regimen oversight. Limited knowledge exists concerning racial and regional polypharmacy variation. We estimated total medication distributions (excluding supplements) of American black and white adults and assessed racial and regional polypharmacy variation. Methods REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort data (N=30,239 U.S. blacks/whites ages ≥45 years) were analyzed. Home pill-bottle inspections assessed the last two weeks’ medications. Polypharmacy (≥ 8 medications) was determined by summing prescription and/or OTC ingredients. Population-weighted logistic regression assessed polypharmacy’s association with census region, race, and gender. Results The mean ingredient number was 4.12 (SE = 0.039), with 15.7% of REGARDS using ≥8 ingredients. In crude comparisons, women used more medications than men, and blacks and whites reported similar mean ingredients. A cross-sectional, logistic model adjusting for demographics, socioeconomics, and comorbidities showed increased polypharmacy prevalence in whites vs. blacks (OR, [95% CI]: 0.63, [0.55–0.72]), women (1.94, [1.68–2.23]), and Southerners {broadly Southeasterners and Texans} (1.48, [1.17–1.87]) vs. Northeasterners {broadly New England and upper Mid-Atlantic}. Possible limitations include polypharmacy misclassification and model mis-specification. Conclusion Polypharmacy is common. Race and geography are associated with polypharmacy variation. Further study of underlying factors explaining these differences is warranted.

OBJECTIVEDespite widespread dissemination of target values, achieving a blood pressure of <130/80 mmHg is challenging for many individuals with diabetes. The purpose of the present study was to examine temporal trends in blood pressure control in hypertensive individuals with diabetes as well as the potential for race, sex, and geographic disparities.RESEARCH DESIGN AND METHODSWe analyzed baseline data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort study of 30,228 adults (58% European American and 42% African American), examining the causes of excess stroke mortality in the southeastern U.S. We calculated mean blood pressure and blood pressure control rates (proportion with blood pressure <130/80 mmHg) for 5,217 hypertensive diabetic participants by year of enrollment (2003–2007) using multivariable logistic regression models.RESULTSOnly 43 and 30% of European American and African American diabetic hypertensive participants, respectively, demonstrated a target blood pressure of <130/80 mmHg (P < 0.001). However, a temporal trend of improved control was evident; the odds of having a blood pressure <130/80 mmHg among diabetic hypertensive participants of both races enrolled in 2007 (as compared with those enrolled in 2003) were ∼50% greater (P < 0.001) in multivariate models.CONCLUSIONSThese data suggest temporal improvements in blood pressure control in diabetes that may reflect broad dissemination of tighter blood pressure control targets and improving medication access. However, control rates remain low, and significant racial disparities persist among African Americans that may contribute to an increased risk for premature cardiovascular disease.

Objectives. To engage pharmacy students at the McWhorter School of Pharmacy in an authentic discussion of professionalism early in their education. Methods. A booklet was prepared that included several classic short stories and essays that dealt with professionalism. This booklet was sent to all entering students in the class of 2008 and 2009 during the summer prior to their first-professional year of the PharmD program. The stories and essays were discussed in small groups with faculty facilitation during orientation when the students first arrived on campus. A survey instrument was created and administered to assess the impact of this innovative approach to enhancing professionalism. Results. The program was well received and engaged our pharmacy students in a productive discussion on professionalism. Both classes' mean scores on survey items related that the students were engaged in the discussion of professionalism. Survey results pertaining to professional behavior also indicated increased awareness of the importance of professionalism. Conclusion. Enhancing professionalism requires a culture change that necessitates addressing professionalism at its core, a calling to serve, in a persistent and continual manner. Requiring students to read and think about professionalism in a novel way, before they even begin their first-professional year of pharmacy school, appears to be an effective approach to nurturing/encouraging professionalism.

Background The extent to which low medication adherence in hypertensive individuals contributes to disparities in stroke and transient ischemic attack (TIA) risk is poorly understood. Methods Investigators examined the relationship between self-reported medication adherence and blood pressure (BP) control (<140/90 mm Hg), Framingham Stroke Risk Score, and physician-adjudicated stroke/TIA incidence in treated hypertensive subjects (n = 15,071; 51% black; 57% in Stroke Belt) over 4.9 years in the national population-based REGARDS cohort study. Results Mean systolic BP varied from 130.8 ± 16.2 mm Hg in those reporting high adherence to 137.8 ± 19.5 mm Hg in those reporting low adherence (P for trend < .0001). In logistic regression models, each level of worsening medication adherence was associated with significant and increasing odds of inadequately controlled BP (≥140/90 mm Hg; score = 1, odds ratio [95% confidence interval], 1.20 [1.09–1.30]; score = 2, 1.27 [1.08–1.49]; score = 3 or 4, 2.21 [1.75–2.78]). In hazard models using systolic BP as a mediator, those reporting low medication adherence had 1.08 (1.04–1.14) times greater risk of stroke and 1.08 (1.03–1.12) times greater risk of stroke or TIA. Conclusion Low medication adherence was associated with inadequate BP control and an increased risk of incident stroke or TIA.