Article Snapshot

Cigarette-smoking, Hypertension, and Cardiovascular Mortality

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In a recent article in the ‘Journal of Hypertension, the authors from the Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing in China examine the risk of cigarette smoking on cardiovascular disease (CVD) and all-cause mortality among hypertensive patients (1).

Progression of coronary atherosclerosis in African-American patients

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African-Americans have higher rates of vascular events compared to whites (1-2). This higher event rates increases the attention to the determinants of atherosclerosis progression and its morphological features in African-Americans. Intravascular ultrasound (IVUS), multislice computed tomography, optical coherence tomography, and magnetic resonance are the imaging tools that employed in clinical practice and research studies.

The Biodiversity Hypothesis and Allergic Disease

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Biodiversity loss and climate change secondary to human activities are increasingly being associated with adverse health effects. A recent position statement of the World Allergy Organization discusses the effects of biodiversity loss on environmental and commensal (indigenous) microbiotas. (1)

Lung Disease and Climate Change

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In a recent article in Chest Drs. Bernstein and Rice from the Center for Health and the Global Environment at the Harvard School of Public Health and Boston Children's Hospital discuss that climate change is a health threat no less consequential than cigarette smoking (1).

Factors associated with compliance to lipid-lowering treatment in China

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Because of rapid changes in lifestyle and risk factors, cardiovascular disease has become the leading cause of death in China. A cross-sectional study in a nationally representative sample of 46 239 adults aged ≥20 years,published in 2012, demonstrated that serum total and low-density lipoprotein cholesterol levels were high and increasing in the Chinese population. (1) The authors predicted that without effective intervention, atherosclerotic cardiovascular diseases may soar in the near future.

Atherosclerosis in Mummies

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Atherosclerosis burden is thought to be related to contemporary lifestyles. A recent paper published in The Lancet described data obtained with whole body CT scans of 137 mummies from four different geographical regions or populations spanning more than 4000 years.

Association between Mortality and Obesity

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In a recent article published in JAMA, the authors describe results from a systematic review of reported hazard ratios (HRs) of all causemortality for overweight  and obesity relative to normal weight in the general population (1).

Long-term survival after aortic valve replacement in octogenarians and high-risk subgroups

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A recent paper in the European Journal of Cardiothoracic Surgery describes long-term outcome after surgical aortic valve replacement (1). The investigators from Norway, state that the increasing age of our populations and improvements in the treatment options for aortic valvular disease have resulted in a considerable rise in the number of elderly patients being admitted for conventional aortic valve surgery.

Non-invasive fractional flow reserve (FFR) from anatomic CT angiography.

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Standard, invasive fractional flow reserve (FFR) is a physiologic measure of coronary stenosis severity, allowing identification of hemodynamic significant lesions during cardiac catheterization. The recently published ‘FAME 2’ trial has provided evidence that PCI of such lesions is a safe and effective therapeutic approach to obtain symptom relief and to decrease the rate of urgent revascularizations in patients with stable coronary artery disease (1).

Global Awareness, Management and Control of Arterial Hypertension

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Arterial hypertension is a global, major public health problem. A recent article in BMJ Open Cardiovascular medicine describes the prevalence, detection, treatment and control rates of hypertension among adults in Cameroon (1). In a cross-sectional, community-based multicentre study in major cities in Cameroon, self-selected urban dwellers from the Center, Littoral, North-West and West Regions, who attended a screening campaign advertised through mass media, were identified. Outcomes measures were hypertension defined as systolic (and/or diastolic) blood pressure (BP) ≥ 140 (90) mm Hg, or ongoing BP-lowering medications.

Cost-utility analysis of transcatheter aortic valve implantation in Belgium

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A significant percentage ofpatients with severe aortic stenosis and coexisting co-morbidities areconsidered high-risk for surgical aortic valve replacement (SAVR) or notconsidered candidates for surgery at all. For these patients, transcatheteraortic valve implantation (TAVI) is suggested as an alternative. Results of thePARTNER (Placement of AoRTic TraNscathetER Valve) trial comparing the clinicaleffectiveness of TAVI with surgical valve replacement and standard therapy havebeen published (1,2).

Western-Style Fast Food Intake and Cardio-Metabolic Risk in an Eastern Country

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In a recent paper published in Circulation, the authors from the University of Minnesota and University of Singapore examined the association of western-style fast food intake with the risk of incident type 2 diabetes (T2D) and coronary heart disease (CHD) mortality in Chinese Singaporeans. (1) In the background, the authors explain that dietary patterns with frequent intake of Western-style fast food contribute to poor cardio-metabolic health in the US. With globalization, this way of eating is becoming more common in developing and recently developed populations. 

Ozone and Cardiovascular Effects

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 In a recent paper published in Circulation, the authors from the US National Health and Environmental Effects Laboratory, and University of North Carolina, examine the impact of Ozone on the cardiovascular system. (Clinical Trial Registration- clinicaltrials.gov Identifier: NCT01492517.)

Article Snapshot: JAMA: Characteristics of clinical trials registered in ClinicalTrials.gov, 2007-2010

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In this paper recently published in JAMA, the authors from the Duke Translational Medicine Institute examine the characteristics of clinical trials registered in the US clinical trial database ‘ClinicalTrials.gov’ (1). The authors describe that recent reports have highlighted gaps between guidelines-based treatment recommendations and supporting evidence from clinical trials.  To further understand these discrepancies, a data set comprising 96,346 clinical studies was downloaded from ‘ClinicalTrials.gov’ in September 2010 and analyzed. Interventional trials were identified and separated according to clinical specialties of cardiovascular, mental health, and oncology. The authors evaluated the characteristics of registered clinical trials in the overall group and in the individual clinical specialty. Furthermore the change of these characteristics was evaluated in two time periods. 

Duration of Dual Antiplatelet Therapy After Coronary Stenting

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The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain incompletely defined. Valgimigli et al. evaluated the impact of up to 6 versus 24 month duration of dual-antiplatelet therapy in randomized multicentre trial (Clinical trial registration: clinicaltrials.gov; Identifier: NCT00611286). (1)

2,013 patients were randomly assigned to receive bare-metal, zotarolimus-eluting, paclitaxel-eluting, or everolimus-eluting stent implantation. At 30 days, patients in each stent group were randomly allocated to receive up to 6 or 24 months clopidogrel therapy on top of aspirin. The primary endpoint was a composite of death from any cause, myocardial infarction or cerebrovascular accident. The cumulative risk of the primary outcome at 2 years was 10.1% with the 24-month dual antiplatelet therapy, as compared to 10.0% with the 6-month dual antiplatelet therapy (hazard ratio, 0.98; 95% CI, 0.74 to 1.29; P = 0.91). The individual risks of death, myocardial infarction, cerebrovascular accident or stent thrombosis did not differ between the study groups. However, there was a consistent greater risk of haemorrhage in the 24-month clopidogrel group according to all pre-specifed bleeding definitions including the recently proposed Bleeding Academic Research Consortium classification.

Growth, Urbanization and Health in China

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In a recent article in the Lancet (1), investigators from the Centre for Earth System Science at Tsinghua University in Beijing (A Ministry of Education Key Laboratory for Earth System Modelling) analyzed the impact of China’s rapid urbanization on public health.

The authors describe that China has experienced the largest human migration in history and that provincial analysis of its urbanization trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. According to the reported data, a growing disease burden in urban areas attributable to nutrition and lifestyle choices (2, 3) is identified as a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution (4) contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorized. 

CT Coronary Angiography in the Emergency Department

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There are about eight million annual ER visits are for chest pain. However, for most of these patients, the symptoms are ultimately found not to have a cardiac cause. Triage of these patients is typically based on history, clinical examination, serial ECG and serial blood tests. Because of its high negative predictive value in selected patient populations, coronary computed tomographic angiography (CTA) may allow early discharge of patients from the emergency department. However, data determining whether such a CTA based strategy is safe is incomplete. 

Comparative Effectiveness of Revascularization Strategies

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In a study recently published in the NEJM (1), funded by the US National Heart, Lung, and Blood Institute, Weintraub et al. describes comparative effectiveness data of long-term survival after percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). In collaboration between the American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS), the authors linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias. 

Article Snapshot: celecoxib, a double-edged sword for patients with angina

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In a recent issue of the European Heart Journal Dr. Kang et al from the Seoul National University Hospital report data about the effects of Celecoxib on restenosis after coronary intervention (1).

A previous trial (2) demonstrated that 6-month adjunctive use of celecoxib reduced target-lesion revascularization (TLR) without increased thrombotic risk. In a larger prospective, randomized trial, Kang et al. aimed to confirm the effects of 3-month celecoxib in patients receiving drug-eluting stent (DES) implantation. 


Dabigatran Association With Higher Risk of Acute Coronary Events Meta-analysis of Noninferiority Randomized Controlled Trials

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In this meta-analysis published in the Archives of Internal Medicine, the authors systematically evaluated the risk of MI or acute coronary syndrome (ACS) with the use of dabigatran.(1) 

PubMed, Scopus, and the Web of Science were searched for randomized controlled trials of dabigatran that reported on MI or ACS as secondary outcomes. The fixed-effects Mantel-Haenszel (M-H) test was used to evaluate the effect of dabigatran on MI or ACS. Associations were expressed as odds ratios (ORs) and their 95% CIs.

Seven trials were selected (N = 30 514), including 2 studies of stroke prophylaxis in atrial fibrillation, 1 in acute venous thromboembolism, 1 in ACS, and 3 of short-term prophylaxis of deep venous thrombosis. Control arms included warfarin, enoxaparin, or placebo administration. 

Dabigatran was significantly associated with a higher risk of MI or ACS than that seen with agents used in the control group (dabigatran, 237 of 20 000 [1.19%] vs control, 83 of 10 514 [0.79%]; ORM-H, 1.33; 95% CI, 1.03-1.71; P = .03). The risk of MI or ACS was similar when using revised RE-LY trial results (ORM-H, 1.27; 95% CI, 1.00-1.61; P = .05) or after exclusion of short-term trials (ORM-H, 1.33; 95% CI, 1.03-1.72; P = .03). Risks were not heterogeneous for all analyses (I2 = 0%; P  .30) and were consistent using different methods and measures of association.

Book Received—The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care [Hardcover]

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First Edition
Author: Eric Topol M.D.

Publication Date: January 31, 2012
ISBN-10: 0465025501
ISBN-13: 978-0465025503

This book describes the increasingly important interface between data digitalization and medicine. A particular focus is the impact of sequencing the human genome, but other topics including electronic medical records, evidence-based medicine, and imaging are covered as well. 

The author is a well-known practicing cardiologist, the director of the Scripps Translational Science Institute, and a respected voice in cardiovascular medicine. He predicts a profound impact of the ‘Digital Revolution’ on the practice of medicine. The book is written for a general audience, and in fact the author describes that this 'revolution' will depend in large part on “digital-natives” outside the medical profession.

Research Highlight on Initial Coronary Stent Implantation with Medical Therapy vs. Medical Therapy Alone for Stable Coronary Artery Disease: Meta-analysis of Randomized Controlled Trials.

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Stergiopoulos K, Brown DL. 
Arch Intern Med. 2012 Feb 27; 172(4): 312-9.

CAD remains a leading cause of morbidity and mortality worldwide. Previous studies have demonstrated a lack of PCI benefit in patient with stable CAD (1). In the current paper, the authors from Division of Cardiovascular Medicine, Department of Medicine, State University of New York-Stony Brook School of Medicine describe results from a meta-analysis of all randomized clinical trials comparing initial coronary stent implantation with medical therapy to determine the effect on death, nonfatal myocardial infarction (MI), unplanned revascularization, and persistent angina (2).

Eight prospective randomized trials enrolling a total of 7229 patients were identified. Three trials enrolled stable patients after MI, whereas 5 studies enrolled patients with stable angina and/or ischemia on stress testing. Mean weighted follow-up was 4.3 years. The respective event rates for death with stent implantation and medical therapy were 8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and 8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4% and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29% and 33% (OR, 0.80; 95% CI, 0.60-1.05).

The authors concluded that initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.

REFERENCES:
1. Boden WE, O'Rourke RA, Teo KK, et al. COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16.
2. Stergiopoulos K, Brown DL. Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease: Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2012 Feb 27;172(4):312-9.
3. Boden WE. Mounting Evidence for Lack of PCI Benefit in Stable Ischemic Heart Disease:What More Will It Take to Turn the Tide of Treatment? Arch Intern Med. 2012;172:319-21.
4. Redberg RF. Informed Strategies for Treating Coronary Disease. Arch Intern Med. 2012 Feb 27;172(4):321. No abstract available. 

Clinical Outcome in Asymptomatic Severe Aortic Stenosis

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In the aging populations of developed nations, aortic stenosis (AS) is one of the most common valvular pathologies, and its prevalence is increasing. Although current guidelines provide clear recommendations for diagnosis and treatment of symptomatic severe AS, inconsistent grading of disease severity remains a problem. Further management of patients with asymptomatic severe AS remains controversial.

New discovery from the Heart of Soweto Study cohort

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Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort

In this study from the Facultyof Health Sciences, Hatter Institute for Cardiovascular Research in Africa andIIDMM, University of Cape Town, Cape Town, South Africa, the authors describedata from the Heart of Soweto Study investigating cardiac manifestations of HIV/AIDS to de novo presentations of heart disease in an urban African community.

518 of5328 de novo cases of heart disease were identified as HIV-positive (9.7%) with54% of these prescribed highly active anti-retroviral therapies onpresentation. The most common primary diagnosis attributable to HIV/AIDS wasHIV-related cardiomyopathy (196 cases, 38%). An additional 128 cases (25%) werediagnosed with pericarditis/pericardial effusion followed by a range of otherconcurrent diagnoses, including 42 cases (8.1%) of HIV-related pulmonaryarterial hypertension. Only 14 of all 581 cases of coronary artery disease(CAD) (2.4%, mean age 41 ± 13 years) were confirmed HIV-positive.

CoreValve (left, courtesy of Medtronic)

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CoreValve (left, courtesy ofMedtronic). SAPIEN 9000 TFX (bottom right)and SAPIEN XT 9300 TFX (top right) valves (courtesy of Edwards LifesciencesInc.)

EchocardiographicGuidance for Diagnostic and Therapeutic Percutaneous Procedures

Cam Tu Nguyen, Eunice Lee, Huai Luo,Robert J Siegel

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Coronary Ostia

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Coronary Ostia and Relationship to Valve Leaflets CT allows to assess therelationship between leaflet height and distance between annulus and coronaryostia, which identifies patients at risk for coronary occlusion during the TAVIprocedure. The movie files demonstrate cine-loops reconstructed at multiplephases of the cardiac cycle. This movie shows the relationship between thecoronary ostia and the valve leaflets.

Computed Tomography in the Evaluation for Transcatheter Aortic Valve Implantation (TAVI)

Paul Schoenhagen, Jörg Hausleiter, StephanAchenbach, Milind Y. Desai, E. Murat Tuzcu

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3D quantitative coronary angiography

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3D quantitative coronaryangiography (3D QCA) and its registration with 3D optical coherence tomography(OCT). A and B are the two angiographic views; C is the reconstructed vesselsegment in color-coded fashion; D. is the OCT cross-sectional viewcorresponding to the middle (red) marker; E is the OCT longitudinal view; and Fis the 3D OCT image. After the registration, the corresponding markers indifferent views (A, B, C, D, and F) were synchronized, allowing the assessmentof lumen dimensions from both imaging modalities at every correspondingposition along the vessel segment.

QCA, IVUS and OCT in interventional cardiology in 2011

JohanH.C. Reiber, Shengxian Tu, Joan C. Tuinenburg, Gerhard Koning, Johannes P.Janssen, Jouke Dijkstra

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