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241. The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association

thoroughly described and evaluated elsewhere. Briefly, they involve measures of association, discrimination, calibration, reclassification, and cost-effectiveness. Other important aspects in the evaluation of biomarkers include safety, replication across different populations, needs to re-educate clinicians and the general public, and usefulness for motivating patients. The first requirement of a novel biomarker is that it is robustly associated with the outcome in question, preferably across different (...) -effectiveness analysis. Some existing risk algorithms, for example, the prediction of coronary heart disease in healthy populations, are already quite accurate, and as a result, additional risk markers need to show very large effect sizes to show any improvement in C statistics. It has been argued that it is a waste of time and resources to perform additional studies trying to discover novel biomarkers for risk prediction and that it would be better to focus on applying preventive measures known

2017 American Heart Association

242. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

therapy in patients with coronary artery disease ACC/AHA 2016 20 Perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery ACC/AHA 2014 21 Lifestyle management to reduce cardiovascular risk AHA/ACC 2013 22 Assessment of cardiovascular risk ACC/AHA 2013 23 Blood cholesterol to reduce atherosclerotic cardiovascular risk in adults ACC/AHA 2013 24 PAD (lower extremity, renal, mesenteric, and abdominal aortic) ACC/AHA 2005 9 and 2011 10 Secondary prevention and risk (...) (microangiopathy) Toes, foot, leg Diabetic microangiopathy End-stage renal disease Thromboangiitis obliterans (Buerger’s) Sickle cell anemia Vasculitis (eg, Churg-Strauss, Henoch-Schonlein purpura, leukocytoclastic vasculitis, microscopic polyangiitis, polyarteritis nodosa) Scleroderma Cryoagglutination Embolic (eg, cholesterol emboli, thromboemboli, endocarditis) Thrombotic (eg, antiphospholipid antibody syndrome, Sneddon’s syndrome, warfarin skin necrosis, disseminated intravascular coagulation, livedoid

2017 American Heart Association

243. Dietary Fats and Cardiovascular Disease (PubMed)

not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower (...) . This report discusses the major classes of dietary fatty acids, except for the very-long-chain n-3 fatty acids in fish, which are covered by other AHA reports. The scientific rationale for decreasing saturated fat in the diet has been and remains based on well-established effects of saturated fat to raise low-density lipoprotein (LDL) cholesterol, a leading cause of atherosclerosis ; to cause atherosclerosis in several animal species, especially nonhuman primates ; to clear the atherosclerosis in animals

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2017 American Heart Association

244. Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association

day eating , late day meals , evening eating , evening meals , obesity , body weight , weight loss , cardiovascular risk , coronary heart disease (CHD), cholesterol , plasma lipids , lipid profile , blood pressure , glucose , insulin , and insulin resistance . Articles were excluded if they did not include original data; if they were editorials, letters, comments, or conferences proceedings; or if they did not meet the inclusion criteria described below. References of the retrieved articles were (...) low-density lipoprotein (LDL) cholesterol, low serum high-density lipoprotein (HDL) cholesterol, and elevated blood pressure. , Conversely, among 415 healthy Korean adults, rare breakfast eaters (eating breakfast 1 of 3 days) were less likely to have elevated serum triglycerides (≥150 mg/dL). Notably, in the Korean study, the percent of TEI from carbohydrates was lower and the percent from fat was higher in rare breakfast eaters, which may explain this observation. Skipping breakfast has been

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2017 American Heart Association

245. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group

existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. Objectives: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. Methods: This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit (...) ordering), clinical effectiveness (eg, blood pressure reduction), or other types of outcomes (eg, cost and utilization and clinician satisfaction). Studies that focused solely on interventions targeting patients, such as those examining patient education or patient reminders, were excluded. The search was limited to English-language resources. 2.3. The Process The ISWG maintained a separation of the collection and compilation of the evidence and the final conclusions. The NHLBI contractor conducted

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2017 American Heart Association

246. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

considerations concerning the role of cholesterol in embryo development and the lack of demonstrated benefit of treating hyperlipidemia during gestation are reasons for not recommending statins during pregnancy. , They remain pregnancy category X drugs in the United States. Fetal Screening During Pregnancy Formal fetal echocardiography at 18 to 22 weeks’ gestation is recommended for all patients with CHD and partners of male patients with CHD ; earlier echocardiographic screening may be recommended

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2017 American Heart Association

247. Potential Impact and Study Considerations of Metabolomics in Cardiovascular Health and Disease: A Scientific Statement From the American Heart Association

that has also been associated with mortality. Given the established importance of lipids (including triacylglycerides and cholesterol-based species) to CVD pathobiology, lipidomic correlates of conventional cholesterol subfractions (eg, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein) have also been the subject of multiple investigations. Studies to date have demonstrated varying degrees of intercorrelation among lipid species, underscoring the potential of lipidomic (...) , proline, and alanine levels, as well as increased concentrations of free fatty acids and products of fatty acid oxidation. More recently, studies of adult twin pairs and age- and sex-matched pairs of unrelated adults have found that more active individuals have better lipoprotein cholesterol profiles and higher levels of polyunsaturated relative to saturated fatty acids. Corroborating the findings from studies of cardiometabolic disease and diabetes mellitus, Kujala et al also found that the BCAA

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2017 American Heart Association

248. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

to understand that the AUC should be used to assess an overall pattern of clinical care rather than being the final arbitrator of specific individual cases. The ACC and its collaborators believe that an ongoing review of one’s practice using these criteria will help guide more effective, efficient, and equitable allocation of healthcare resources, and ultimately, better patient outcomes . However, under no circumstances should the AUC be used to adjudicate or determine payment for individual patients

2017 Society for Cardiovascular Angiography and Interventions

249. Management of Dyslipidaemia

. Applicability of the Guidelines and Resource Implications: This guideline was developed taking into account our local health resources. Blood chemistry for lipid profiles, liver and renal function tests can be done in all government health facilities. Almost all the medications recommended (except for the PCSK9 inhibitors) are approved for use in Malaysia and available in public hospitals as generics. This guideline aims to educate health care professional on strategies to optimize existing resources (...) . Atherosclerosis affects the entire vascular tree. However, evidence for a causal link is strongest for CVD (heart disease and strokes). • Strategies for assessing CV risk that is most applicable to our local population. • Evidence based management of dyslipidaemia, utilising existing healthcare resources wherever possible. Process: This CPG has been drawn up by a committee appointed by the National Heart Association of Malaysia, Ministry of Health and the Academy of Medicine. It comprises cardiologists

2017 Ministry of Health, Malaysia

250. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

Rosuvastatin; LDL-C = low-density lipoprotein cholesterol; Lp-PLA2 = lipoprotein-associ- ated phospholipase A2; MACE = major cardiovascular events; MESA = Multi-Ethnic Study of Atherosclerosis; MetS = metabolic syndrome; MI = myocardial infarc- tion; MRFIT = Multiple Risk Factor Intervention Trial; NCEP = National Cholesterol Education Program; NHLBI = National Heart, Lung, and Blood Institute; PCOS = polycystic ovary syndrome; PCSK9 = propro- tein convertase subtilisin/kexin type 9; Post CABG = CPG (...) of Clinical Endocrinologists (AACE) Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Dyslipidemia and Prevention of Atherosclerosis (6 [EL 4; NE]), and complements the AACE Diabetes Mellitus Comprehensive Care Plan CPG (7 [EL 4; NE]). The landmark National Cholesterol Education Program (NCEP) guidelines (8 [EL 4; NE]) serve as the backbone of these lipid recommendations. This CPG is unique in that it supports the use of apoli- poprotein (apo) B level and/or LDL particle

2017 American Association of Clinical Endocrinologists

251. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

adult CHD (ACHD) admissions to an intensive care unit, abnormal thyroid, creatinine, and bilirubin tests were highly pre- dictive of both intensive care unit and hospital mortal- ity. 19 Furthermore, comorbidities can be costly. A recent study demonstrated renal insufficiency as a primary driver of high resource use for ACHD hospitalizations, which account for only 10% of the admissions but make up one third of the total hospital charges. 20 The impact of noncardiac comorbidities on both car- diac (...) and it is imperative that centers allocate resourc- es to provide comprehensive care to this population. To further decrease morbidity and mortality in patients with CHD, understanding and managing noncardiac complications becomes as important as knowing their cardiac history. This review covers some of the organ systems most frequently affected in the adult with CHD (Figure 1). RENAL Prevalence Renal dysfunction has long been described in cyanotic CHD but is common among adults with all forms of CHD. 26,27

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2017 American Heart Association

252. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Treatment and Control e71 12.1. Adherence Strategies for Treatment of Hypertension e71 12.1.1. Antihypertensive Medication Adherence Strategies e71 12.1.2. Strategies to Promote Lifestyle Modification e71 12.1.3. Improving Quality of Care for Resource-Constrained Populations e72 12.2. Structured, Team-Based Care Interventions for Hypertension Control e73 12.3. Health Information Technology–Based Strategies to Promote Hypertension Control e73 12.3.1. EHR and Patient Registries e73 12.3.2. Telehealth (...) Council recommended that the NHLBI focus specifically on reviewing the highest-quality evidence and partner with other organizations to develop recommendations. Accordingly, the ACC and AHA collaborated with the NHLBI and stakeholder and professional organizations to complete and publish 4 guidelines (on assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol in adults, and management of overweight and obesity in adults) to make them

2017 American Heart Association

253. American Heart Association Principles on the Accessibility and Affordability of Drugs and Biologics: A Presidential Advisory From the American Heart Association

, , , and September 2011 , , , , , and September 2008 February 1998 December 12, 2017 Vol 136, Issue 24 Article Information Metrics Download : 250 © 2017 American Heart Association, Inc. PubMed Originally published November 9, 2017 Keywords Subjects Title Title Title Title Circulation AHA Journals Journal Information Subjects Features Resources & Education For Authors & Reviewers National Center 7373 Greenville Ave. Dallas, TX 75231 Customer Service 1-800-AHA-USA-1 1-800-242-8721 ABOUT US OUR SITES TAKE ACTION (...) in and testing of precision medicine diagnostics and treatments will bring additional costs in the short term. Although there is a lack of consensus as to the importance or magnitude of the contribution of any factor to this pricing trend, there is agreement that no one healthcare stakeholder, nor the system as a whole, can afford it. Recognizing this fact, dialogue has begun about assessing value as a way to match payment and resource allocation decisions to a product’s alignment with patient, societal

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2017 American Heart Association

254. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

, and other government agencies, brings together in a single document the most up- to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure 1 ), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals (...) Behaviors 3. Smoking/Tobacco Use . . . . . . . . . . . . . . e183 4. Physical Inactivity . . . . . . . . . . . . . . . . e196 5. Nutrition . . . . . . . . . . . . . . . . . . . . . e214 6. Overweight and Obesity . . . . . . . . . . . . . e240 Health Factors and Other Risk Factors 7. Family History and Genetics . . . . . . . . . . . e263 8. High Blood Cholesterol and Other Lipids . . . . . e270 9. High Blood Pressure . . . . . . . . . . . . . . . e280 10. Diabetes Mellitus

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2017 American Heart Association

255. Methodological Standards for Meta-Analyses and Qualitative Systematic Reviews of Cardiac Prevention and Treatment Studies: A Scientific Statement From the American Heart Association

that there is a distribution of true effect sizes among the studies in the analysis (ie, effect sizes may vary from study to study.) Effect sizes may vary on the basis of many factors, including the age, education, or sex of participants or the intensity of the intervention.Forest plot: a visual summary of a meta-analysis in which the effect size estimate, confidence interval, and weight of each study are presented along with the pooled summary effect size estimate and confidence interval.Cumulative meta-analysis: Data

2017 American Heart Association

256. Recommendation on Design, Execution, and Reporting of Animal Atherosclerosis Studies: A Scientific Statement From the American Heart Association

of these studies that should be deliberated. Insights Provided by Animal Models There has been a long history of using animal models to provide insight into mechanisms of human atherosclerosis. A large number of animal studies have contributed to the notion that lowering plasma cholesterol concentrations is an effective mode of reducing atherosclerosis, which has led to therapeutic approaches for reducing plasma cholesterol concentration to effectively reduce atherosclerosis-related diseases in humans (...) ) transgene expression in hypercholesterolemic mice in reducing atherosclerosis. , These observations contributed to the development of high-density lipoprotein (HDL) infusion therapies in humans. Similarly, mouse studies provided the first evidence that PCSK9 (proprotein convertase subtilisin/kexin type 9) increases plasma low-density lipoprotein (LDL) cholesterol concentrations by reducing expression of LDL receptors and showed that PCSK9 was secreted by the liver, which implied that circulating PCSK9

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2017 American Heart Association

257. Defining Optimal Brain Health in Adults

brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA’s Life’s Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m 2 ) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol (...) to be highest in South Korea, western European countries, and some emerging economies. Anticipated gains in longevity will occur in older age groups, particularly among women. By 2030, it is estimated there will be a >50% probability that women in some of the aforementioned regions will break the 90-year survival barrier. These gains may be explained by improvements in social status, education, and childhood and adolescent nutrition; expanded primary and secondary health care; a rapid scale-up of new

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2017 American Heart Association

258. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non?ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update 4. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 5. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline (...) that a separate outpatient CAD measure set will likely address smoking cessation advice/counseling). The writing committee also recognizes the importance of the American Medical Association/Physician Consortium for Performance Improvement Tobacco Use: Screening and Cessation Intervention measure that already exists. QM-1 Inpatient LDL Cholesterol Assessment This measure is being retired to be concordant with the new lipid guidelines that no longer recommend LDL measurements to target statin prescription

2017 American Heart Association

259. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association (PubMed)

Development in Young Adults), in which 26 of the 27 incident heart failure cases that occurred in individuals <50 years of age were among black participants. Although disparities in heart failure persist in middle-aged and older adults (mean age, 62 years) in MESA (Multi-Ethnic Study of Atherosclerosis; HR, 1.81; 95% CI, 1.07–3.07 in African Americans versus whites), statistical adjustment for established risk factors (ie, age, sex, diabetes mellitus, hypertension, cholesterol, smoking status, and left (...) to or lower than those of non-Hispanic whites. For example, the prevalence of elevated total cholesterol (≥200 mg/dL) was 37.0% in non-Hispanic white males versus 32.6% in non-Hispanic blacks in NHANES 2011 to 2014. Comparable percentages of elevated total cholesterol among women were 43.4% among non-Hispanic whites and 36.1% in non-Hispanic blacks. High-density lipoprotein (HDL) cholesterol is known to be higher in African Americans, and in recent estimates from NHANES, those patterns hold

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2017 American Heart Association

260. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

mass index, systolic blood pressure, hypertension treatment, diabetes mellitus, current smoking, ratio of total to high-density lipoprotein cholesterol, valvular heart disease, and prevalent myocardial infarction (Framingham Heart Score). Other data further support the potential utility of natriuretic peptides to predict the long-term development of HF. Older adults with initially low biomarker concentrations that demonstrated a rise in both NT-proBNP >25% and cardiac troponin T (cTnT) >50% over (...) -guided prognostication may aid resource allocation. Biomarker-assisted prognostication also facilitates patient-provider communication and the shared decision-making process. Clear communication about prognosis helps to establish patient-caregiver expectations about the short- and long-term goals of care. Finally, biomarker-guided risk prediction can aid patient selection for clinical trials by identifying patients at highest risk of clinical events. Natriuretic Peptides Values of BNP and NT-proBNP

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2017 American Heart Association

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