Cholesterol-Lowering Drugs and Therapies in Cardiovascular Disease

Dyslipidemia is a major risk factor for cardiovascular disease (CVD). The relationship between low-density lipoprotein concentration and cardiovascular (CV) risk has been well established in numerous epidemiological studies. The benefit of cholesterol-lowering agents has been demonstrated in patients with known CVD. On the other hand, in patients without known CVD the decision to start therapy depends on their 10-year risk prediction of CV events. 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (“statins”), a mainstay of cholesterol-lowering therapy, have been shown to reduce both CV events and all-cause mortality. Other lipid-lowering measures (both pharmacological and nonpharmacological) have also been demonstrated in clinical trials to reduce CV outcomes. In this chapter, we review contemporary therapies used to treat dyslipidemia and discuss future directions including novel agents on the horizon

Diagnosis and Surveillance of Aortic Root Dilation

Aortic root dilation (AoD) imparts increased risk of aortic complications such as dissection, rupture, and valvular regurgitation. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities, and pharmacologic therapies is critical. This chapter will review the various etiologies of AoD, pathophysiological basis of each disease entity, overview of the diagnosis of AoD, noninvasive imaging modalities employed for detection and surveillance, pharmacological therapies used in the prevention and management, and the factors that guide intervention such as surgical repair

Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study.

BACKGROUND: Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM. METHODS AND RESULTS: In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (18F-fluorodeoxyglucose uptake, expressed as target-to-background ratio) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced computed tomographic angiography was performed to characterize the presence of HRM (defined as noncalcified or partially calcified plaques) in the LMCA. Arterial inflammation (target-to-background ratio) was higher in LMCA segments with HRM than those without HRM (mean±SEM: 1.95±0.43 versus 1.67±0.32 for LMCA with versus without HRM, respectively; P=0.04). Moreover, atorvastatin treatment for 12 weeks reduced target-to-background ratio more in LMCA segments with HRM than those without HRM (12 week-baseline Δtarget-to-background ratio [95% confidence interval]: -0.18 [-0.35 to -0.004] versus 0.09 [-0.06 to 0.26]; P=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline low-density lipoprotein and statin dose (β=-0.27; P=0.038). CONCLUSIONS: In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain HRM features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00703261.National Heart, Lung, and Blood Institute of the National Institutes of Health (5T32 HL076136) and Marfan Foundation, National Institute for Health Research Cambridge Biomedical Research Centre, British Heart Foundation, Wellcome Trus

Heat transfer and friction factor correlation for inclined spherical ball roughened solar air heater

Flow mechanism under roughened solar air heater is quite complex. This paper is an effort towards determining the governing equations for heat transfer and friction factor for inclined spherical balls roughened ducts. With the availability of these equations, it is easier to predict the thermal and thermohydraulic performance of such roughened solar air heaters. The governing equations are derived based on the experimental data generated under actual outdoor condition at the test rig designed and fabricated at the terrace of the Mechanical Engineering Department, the National Institute of Technology Jamshedpur in India, in terms of roughness and flow parameters. Maximum augmentation in Nusselt number and friction factor for varying relative roughness pitch, relative roughness height, spherical ball height to diameter ratio, and angle of attack was respectively found to be of the order of 2.1 to 3.54 times, 1.87 to 3.21 times, 2.89 to 3.27 times and 1.74 to 3.56 times for Nusselt number and 0.84 to 1.79 times, 1.46 to 1.91 times, 1.67 to 2.34 times and 1.21 to 2.67 times for friction factor in comparison to non-roughened duct. The optimum roughness parameters under present investigation have been found

Forest disturbance detection in Garhwal Himalayas using MODIS NDVI time-series and BFAST model

In this study, the BFAST model was used to decompose MODIS NDVI time-series and detect negative abrupt changes within trend during the study period (2005 to 2018). These negative abrupt changes were filtered and assigned as disturbances in the selected forest classes. The results showed that on average 15.01% of the forests were disturbed annually and 86.84% area was affected during the whole study period. The selected forests were affected the most in year 2008, 2011, and 2016. The model validation established a strong agreement between measured and estimated disturbance with 92.63% overall accuracy and kappa coefficient value of 0.86. The information about the time, extent, and impact of disturbances derived from remote sensing and GIS might be a critical tool for the degradation evaluation of forest ecosystem and also help in the development of forest management policies for sustainable development of the Himalayan region