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Latest & greatest articles for cardiovascular disease
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Simulation of Lipid-Lowering Therapy Intensification in a Population With Atherosclerotic CardiovascularDisease 28768335 2018 11 13 2380-6591 2 9 2017 Sep 01 JAMA cardiology JAMA Cardiol Simulation of Lipid-Lowering Therapy Intensification in a Population With Atherosclerotic CardiovascularDisease. 959-966 10.1001/jamacardio.2017.2289 In patients with atherosclerotic cardiovasculardisease (ASCVD), guidelines recommend optimizing statin treatment, and consensus pathways suggest use (...) of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in patients with persistently elevated low-density lipoprotein cholesterol (LDL-C) levels despite use of statins. Recent trials have provided evidence of benefit in reduction of cardiovascular events with these agents. To estimate the percentage of patients with ASCVD who would require a PCSK9 inhibitor when oral lipid-lowering therapy (LLT) is intensified first. This simulation model study used a large administrative
Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease: A Secondary Analysis of a Randomized Trial. Background: The public health significance of the reported higher incidence of chronic kidney disease (CKD) with intensive systolic blood pressure (SBP) lowering is unclear. Objective: To examine the effects of intensive SBP lowering on kidney and cardiovascular outcomes and contrast its apparent beneficial and adverse effects (...) . Design: Subgroup analyses of SPRINT (Systolic Blood Pressure Intervention Trial). (ClinicalTrials.gov: NCT01206062 ). Setting: Adults with high blood pressure and elevated cardiovascular risk. Participants: 6662 participants with a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. Intervention: Random assignment to an intensive or standard SBP goal (120 or 140 mm Hg, respectively). Measurements: Differences in mean eGFR during follow-up (estimated with a linear mixed
Gonadotropin-releasing Hormone Agonists, Orchiectomy, and Risk of CardiovascularDisease: Semi-ecologic, Nationwide, Population-based Study 28711383 2017 07 16 2017 08 02 1873-7560 2017 Jul 12 European urology Eur. Urol. Gonadotropin-releasing Hormone Agonists, Orchiectomy, and Risk of CardiovascularDisease: Semi-ecologic, Nationwide, Population-based Study. S0302-2838(17)30536-5 10.1016/j.eururo.2017.06.036 In observational studies, men with prostate cancer treated with gonadotropin (...) -releasing hormone (GnRH) agonists had a higher risk of cardiovasculardisease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk. To investigate the association of type of androgen deprivation therapy (ADT) with risk of CVD while minimising selection bias. Semi-ecologic study of 6556 men who received GnRH agonists and 3330 men who underwent orchiectomy as primary treatment during 1992-1999 in the Prostate Cancer Database Sweden 3.0. We measured
A policy model of cardiovasculardisease in moderate-to-advanced chronic kidney disease 28780579 2017 08 06 2017 08 06 1468-201X 2017 Aug 05 Heart (British Cardiac Society) Heart A policy model of cardiovasculardisease in moderate-to-advanced chronic kidney disease. heartjnl-2016-310970 10.1136/heartjnl-2016-310970 To present a long-term policy model of cardiovasculardisease (CVD) in moderate-to-advanced chronic kidney disease (CKD). A Markov model with transitions between CKD stages (3B, 4 (...) cardiovascular events and advanced CKD were the main contributors to increased individual disease risks. CKD and CVD risks predicted by the state-transition model corresponded well to risks observed in SHARP and external cohorts. The model's predictions of vascular risk and progression to end-stage renal disease were better than, or comparable to, those produced by other risk scores. As an illustration, at age 60-69 years, projected survival for SHARP participants in CKD stage 3B was 13.5 years (10.6 quality
Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease 28797349 2017 08 11 2017 09 01 2017 09 01 1558-3597 70 7 2017 Aug 15 Journal of the American College of Cardiology J. Am. Coll. Cardiol. Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease. 813-826 S0735-1097(17)37853-1 10.1016/j.jacc.2017.06.030 Currently, there is no generally accepted model to predict outcomes in stable coronary heart disease (...) (CHD). This study evaluated and compared the prognostic value of biomarkers and clinical variables to develop a biomarker-based prediction model in patients with stable CHD. In a prospective, randomized trial cohort of 13,164 patients with stable CHD, we analyzed several candidate biomarkers and clinical variables and used multivariable Cox regression to develop a clinical prediction model based on the most important markers. The primary outcome was cardiovascular (CV) death, but model performance
Fruit, vegetable, and legume intake, and cardiovasculardisease and deaths in 18 countries (PURE): a prospective cohort study. BACKGROUND: The association between intake of fruits, vegetables, and legumes with cardiovasculardisease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. METHODS: We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE (...) ] in 135 335 individuals aged 35 to 70 years without cardiovasculardisease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education
Associations of fats and carbohydrate intake with cardiovasculardisease and mortality in 18 countries from five continents (PURE): a prospective cohort study. BACKGROUND: The relationship between macronutrients and cardiovasculardisease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. METHODS: The Prospective Urban Rural Epidemiology (PURE) study (...) is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovasculardisease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions
Rivaroxaban with or without Aspirin in Stable CardiovascularDisease. Background We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. Methods In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily (...) in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. Conclusions Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than
Reliability of Cardiovascular Risk Calculators to Estimate Accurately the Risk of CardiovascularDisease in Patients With Sarcoidosis 28705378 2017 07 14 2017 08 15 1879-1913 120 5 2017 Sep 01 The American journal of cardiology Am. J. Cardiol. Reliability of Cardiovascular Risk Calculators to Estimate Accurately the Risk of CardiovascularDisease in Patients With Sarcoidosis. 868-873 S0002-9149(17)30966-9 10.1016/j.amjcard.2017.05.060 Chronic inflammation is an independent risk factor (...) for cardiovasculardisease (CVD), but most risk calculators, including the Framingham risk score (FRS) and the American College of Cardiology (ACC)/American Heart Association (AHA) risk score do not account for it. These calculators underestimate cardiovascular risk in patients with rheumatoid arthritis and systemic lupus erythematosus. To date, how these scores perform in the estimation of CVD risk in patients with sarcoidosis has not been assessed. In this study, the FRS and the ACC/AHA risk score were
Application of a Lifestyle-Based Tool to Estimate Premature CardiovascularDisease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study 28715555 2017 07 17 2017 07 17 2168-6114 2017 Jul 17 JAMA internal medicine JAMA Intern Med Application of a Lifestyle-Based Tool to Estimate Premature CardiovascularDisease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. 10.1001/jamainternmed.2017.2922 Few tools exist (...) for assessing the risk for early atherosclerotic cardiovasculardisease (ASCVD) events in young adults. To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age. This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985
CardiovascularDisease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review. Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular (...) disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age
Behavioral Counseling to Promote a Healthful Diet and Physical Activity for CardiovascularDisease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement. Importance: Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not. All persons, regardless of their risk status for cardiovasculardisease (CVD), can gain health benefits (...) from healthy eating behaviors and appropriate physical activity. Objective: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on behavioral counseling to promote a healthful diet and physical activity for cardiovasculardisease prevention among adults without obesity who do not have cardiovascular risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). Evidence Review: The USPSTF reviewed the evidence on whether primary care-relevant
Benchmarking life expectancy and cancer mortality: global comparison with cardiovasculardisease 1981-2010. Objective To quantify the impact of cancer (all cancers combined and major sites) compared with cardiovasculardisease (CVD) on longevity worldwide during 1981-2010. Design Retrospective demographic analysis using aggregated data. Setting National civil registration systems in member states of the World Health Organization. Participants 52 populations with moderate to high quality data (...) on cause specific mortality. Main outcome measures Disease specific contributions to changes in life expectancy in ages 40-84 (LE 40-84 ) over time in populations grouped by two levels of Human Development Index (HDI) values. Results Declining CVD mortality rates during 1981-2010 contributed to, on average, over half of the gains in LE 40-84 ; the corresponding gains were 2.3 (men) and 1.7 (women) years, and 0.5 (men) and 0.8 (women) years in very high and medium and high HDI populations, respectively
Clonal Hematopoiesis and Risk of Atherosclerotic CardiovascularDisease. Background Clonal hematopoiesis of indeterminate potential (CHIP), which is defined as the presence of an expanded somatic blood-cell clone in persons without other hematologic abnormalities, is common among older persons and is associated with an increased risk of hematologic cancer. We previously found preliminary evidence for an association between CHIP and atherosclerotic cardiovasculardisease, but the nature (...) of this association was unclear. Methods We used whole-exome sequencing to detect the presence of CHIP in peripheral-blood cells and associated such presence with coronary heart disease using samples from four case-control studies that together enrolled 4726 participants with coronary heart disease and 3529 controls. To assess causality, we perturbed the function of Tet2, the second most commonly mutated gene linked to clonal hematopoiesis, in the hematopoietic cells of atherosclerosis-prone mice. Results
Usefulness of Multiple Biomarkers for Predicting Incident Major Adverse Cardiac Events in Patients Who Underwent Diagnostic Coronary Angiography (from the Catheter Sampled Blood Archive in CardiovascularDiseases [CASABLANCA] Study) 28487034 2017 05 10 2017 06 12 1879-1913 120 1 2017 Jul 01 The American journal of cardiology Am. J. Cardiol. Usefulness of Multiple Biomarkers for Predicting Incident Major Adverse Cardiac Events in Patients Who Underwent Diagnostic Coronary Angiography (from (...) the Catheter Sampled Blood Archive in CardiovascularDiseases [CASABLANCA] Study). 25-32 S0002-9149(17)30636-7 10.1016/j.amjcard.2017.03.265 We sought to develop a multiple biomarker approach for prediction of incident major adverse cardiac events (MACE; composite of cardiovascular death, myocardial infarction, and stroke) in patients referred for coronary angiography. In a 649-participant training cohort, predictors of MACE within 1 year were identified using least-angle regression; over 50 clinical