Measurement of low‐density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry

Background The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low-density lipoprotein cholesterol ( LDL -C) to identify untreated patients with LDL -C ≥190 mg/dL, assess lipid-lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines. Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL -C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL -C levels measured in the 2 years before enrollment. Patients without chart-documented LDL -C levels were more often women, nonwhite, uninsured, and non-college graduates (all P\u3c0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high-intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid-lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL -C levels at enrollment (median 97 versus 92 mg/dL; P\u3c0.0001) than patients with prior LDL -C testing. Of 166 individuals with core laboratory LDL -C levels ≥190 mg/dL, 36.1% had no LDL -C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment. Conclusions In routine clinical practice, LDL -C testing is associated with higher-intensity lipid-lowering treatment and lower achieved LDL -C level

Hyperelastic tuning of one dimensional phononic band-gaps using directional stress

JMC acknowledges EPSRC Fellowship (EP/K027611/1) and the ERC advanced investigator award (340117 - Biophononics).In this paper we show that acoustoelasticity in hyperelastic materials can be understood using the framework of non-linear wave mixing, which, when coupled with an induced static stress, leads to a change in the phase velocity of the propagating wave with no change in frequency. By performing Floquet wave eigenvalue analysis, we also show that band-gaps for periodic composites, acting as 1D phononic crystals, can be tuned using this static stress. In the presence of second order elastic nonlinearities, the phase velocity of propagating waves in the phononic structure changes, leading to observable shifts in the band-gaps. Finally, we present numerical examples as evidence that the band-gaps are tuned by both the direction of the stress and its magnitude.Publisher PDFPeer reviewe

Fasting and postchallenge glycemia and cardiovascular disease risk. The Framingham Offspring Study

WSTĘP. Celem pracy było zbadanie słuszności hipotezy, według której hiperglikemia na czczo (FHG, fasting hyperglycemia) i glikemia 2 godziny po obciążeniu glukozą (2hPG, 2-h postchallenge glycemia) niezależnie zwiększają ryzyko chorób sercowo-naczyniowych (CVD, cardiovascular disease). MATERIAŁ I METODY. W latach 1991-1995 autorzy przebadali 3370 uczestników badania Framingham Offspring Study, u których nie występowały objawy kliniczne CVD (choroba wieńcowa, udar mózgu lub chromanie przestankowe) ani cukrzyca, wymagająca leczenia farmakologicznego. Okres obserwacji pod kątem występowania CVD wynosił 4 lata. W celu oceny ryzyka związanego z FHG (stężenie glukozy na czczo ł 7,0 mmol/l) i 2hPG niezależnie od wpływu standardowych czynników ryzyka CVD, zastosowano model regresji proporcjonalnego ryzyka Coxa. WYNIKI. Średni wiek badanych wynosił 54 lata, 54% chorych stanowiły kobiety. Uprzednio nierozpoznaną cukrzycę stwierdzono u 3,2% na podstawie FHG, a u 4,9% (164 osoby), opierając się na wartościach FHG lub 2hPG ł 11,1 mmol/l. Spośród tych 164 chorych u 55 (33,5%) 2hPG było ł 11,1 mmol/ przy prawidłowym FHG, ale stanowiły one jedynie 1,7% z 3261 badanych bez FHG. W czasie 12 242 pacjentolat obserwacji wystąpiło 118 incydentów CVD. W oddzielnych modelach, skorygowanych względem płci i standardowych czynników ryzyka chorób sercowo-naczyniowych, ryzyko względne (RR, relative risk) CVD dla glikemii na czczo (FPG, fasting plasma glucose) większej lub równej 7,0 mmol/l wynosiło 2,8 (95% przedział ufności 1,6–5,0), a dla wzrostu 2hPG o 2,1 mmol/l - 1,2 (1,1–1,3). W modelu wspólnym RR dla FHG zmalało i wynosiło 1,5 (0,7–3,6), podczas gdy RR dla 2hPG pozostało istotnie podwyższone (1,1; 1,02–1,3). Analiza statystyczna c dla modelu obejmującego jedynie standardowe czynniki ryzyka CVD wyniosła 0,744; po dołączeniu FHG - 0,746, a po dodaniu FHG i 2hPG - 0,752. WNIOSKI. Glikemia po doustnym obciążeniu glukozą jest niezależnym czynnikiem ryzyka chorób sercowo-naczyniowych, ale wartość predykcyjna 2hPG jest niewielka w stosunku do standardowych czynników ryzyka CVD.INTRODUCTION. To test the hypothesis that fasting hyperglycemia (FHG) and 2-h postchallenge glycemia (2hPG) independently increase the risk for cardiovascular disease (CVD). MATERIAL AND METHODS. During 1991–1995, we examined 3,370 subjects from the Framingham Offspring Study who were free from clinical CVD (coronary heart disease, stroke, or intermittent claudication) or medication-treated diabetes, and we followed them for 4 years for incident CVD events. We used proportional-hazards regression to assess the risk associated with FHG (fasting plasma glucose ≥ 7.0 mmol/l) and 2hPG, independent of the risk predicted by standard CVD risk factors. RESULTS. Mean subject age was 54 years, 54% were women, and previously undiagnosed diabetes was present in 3.2% by FHG and 4.9% (164) by FHG or a 2hPG ≥ 11.1 mmol/l. Of these 164 subjects, 55 (33.5%) had 2hPG ≥ 11.1 without FHG, but these 55 subjects represented only 1.7% of the 3,261 subjects without FHG. During 12,242 person-years of follow-up, there were 118 CVD events. In separate sex- and CVD risk-adjusted models, relative risk (RR) for CVD with fasting plasma glucose ≥ 7.0 mmol/l was 2.8 (95% CI 1.6–5.0); RR for CVD per 2.1 mmol/l increase in 2hPG was 1.2 (1.1–1.3). When modeled together, the RR for FHG decreased to 1.5 (0.7–3.6), whereas the RR for 2hPG remained significant (1.1, 1.02–1.3). The c-statistic for a model including CVD risk factors alone was 0.744; with addition of FHG, it was 0.746, and with FHG and 2hPG, it was 0.752. CONCLUSIONS. Postchallenge hyperglycemia is an independent risk factor for CVD, but the marginal predictive value of 2hPG beyond knowledge of standard CVD risk factors is small

Electrons in an annealed environment: A special case of the interacting electron problem

The problem of noninteracting electrons in the presence of annealed magnetic disorder, in addition to nonmagnetic quenched disorder, is considered. It is shown that the proper physical interpretation of this model is one of electrons interacting via a potential that is long-ranged in time, and that its technical analysis by means of renormalization group techniques must also be done in analogy to the interacting problem. As a result, and contrary to previous claims, the model does not simply describe a metal-insulator transition in $d=2+\epsilon$ ($\epsilon\ll 1$) dimensions. Rather, it describes a transition to a ferromagnetic state that, as a function of the disorder, precedes the metal-insulator transition close to $d=2$. In $d=3$, a transition from a paramagnetic metal to a paramagnetic insulator is possible.Comment: 13 pp., LaTeX, 2 eps figs; final version as publishe

Aggregate Risk Score Based on Markers of Inflammation, Cell Stress, and Coagulation Is an Independent Predictor of Adverse Cardiovascular Outcomes

Objectives: This study sought to determine an aggregate, pathway-specific risk score for enhanced prediction of death and myocardial infarction (MI). Background Activation of inflammatory, coagulation, and cellular stress pathways contribute to atherosclerotic plaque rupture. We hypothesized that an aggregate risk score comprised of biomarkers involved in these different pathways - high-sensitivity C-reactive protein (CRP), fibrin degradation products (FDP), and heat shock protein 70 (HSP70) levels - would be a powerful predictor of death and MI. Methods: Serum levels of CRP, FDP, and HSP70 were measured in 3,415 consecutive patients with suspected or confirmed coronary artery disease (CAD) undergoing cardiac catheterization. Survival analyses were performed with models adjusted for established risk factors. Results: Median follow-up was 2.3 years. Hazard ratios (HRs) for all-cause death and MI based on cutpoints were as follows: CRP ≥3.0 mg/l, HR: 1.61; HSP70 >0.625 ng/ml, HR; 2.26; and FDP ≥1.0 μg/ml, HR: 1.62 (p < 0.0001 for all). An aggregate biomarker score between 0 and 3 was calculated based on these cutpoints. Compared with the group with a 0 score, HRs for all-cause death and MI were 1.83, 3.46, and 4.99 for those with scores of 1, 2, and 3, respectively (p for each: <0.001). Annual event rates were 16.3% for the 4.2% of patients with a score of 3 compared with 2.4% in 36.4% of patients with a score of 0. The C statistic and net reclassification improved (p < 0.0001) with the addition of the biomarker score. Conclusions: An aggregate score based on serum levels of CRP, FDP, and HSP70 is a predictor of future risk of death and MI in patients with suspected or known CAD

Ab Initio Calculation of the Lattice Distortions induced by Substitutional Ag- and Cu- Impurities in Alkali Halide Crystals

An ab initio study of the doping of alkali halide crystals (AX: A = Li, Na, K, Rb; X = F, Cl, Br, I) by ns2 anions (Ag- and Cu-) is presented. Large active clusters with 179 ions embedded in the surrounding crystalline lattice are considered in order to describe properly the lattice relaxation induced by the introduction of substitutional impurities. In all the cases considered, the lattice distortions imply the concerted movement of several shells of neighbors. The shell displacements are smaller for the smaller anion Cu-, as expected. The study of the family of rock-salt alkali halides (excepting CsF) allows us to extract trends that might be useful at a predictive level in the study of other impurity systems. Those trends are presented and discussed in terms of simple geometric arguments.Comment: LaTeX file. 8 pages, 3 EPS pictures. New version contains calculations of the energy of formation of the defects with model clusters of different size

10-Year Resource Utilization and Costs for Cardiovascular Care

Background: Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. Objectives: This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. Methods: Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code–specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars. Results: Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78$2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level \u3e3 mg/l, or coronary artery calcium score (CACS) ≥400. Costs varied widely from \u3c$7,700 for low-risk (Framingham risk score \u3c6%, 0 CACS, and normal glucose measurements at baseline) to \u3e$35,800 for high-risk (persons with diabetes, Framingham risk score ≥20$74 million of the $155 million consumed by MESA participants. Conclusions: Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals

Effects of Prandial Versus Fasting Glycemia on Cardiovascular Outcomes in Type 2 Diabetes: The HEART2D trial

OBJECTIVE—Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) is a multinational, randomized, controlled trial designed to compare the effects of prandial versus fasting glycemic control on risk for cardiovascular outcomes in patients with type 2 diabetes after acute myocardial infarction (AMI)

Inhaled Nanoparticles Accumulate at Sites of Vascular Disease

The development of engineered nanomaterials is growing exponentially, despite concerns over their potential similarities to environmental nanoparticles that are associated with significant cardiorespiratory morbidity and mortality. The mechanisms through which inhalation of nanoparticles could trigger acute cardiovascular events are emerging, but a fundamental unanswered question remains: Do inhaled nanoparticles translocate from the lung in man and directly contribute to the pathogenesis of cardiovascular disease? In complementary clinical and experimental studies, we used gold nanoparticles to evaluate particle translocation, permitting detection by high-resolution inductively coupled mass spectrometry and Raman microscopy. Healthy volunteers were exposed to nanoparticles by acute inhalation, followed by repeated sampling of blood and urine. Gold was detected in the blood and urine within 15 min to 24 h after exposure, and was still present 3 months after exposure. Levels were greater following inhalation of 5 nm (primary diameter) particles compared to 30 nm particles. Studies in mice demonstrated the accumulation in the blood and liver following pulmonary exposure to a broader size range of gold nanoparticles (2-200 nm primary diameter), with translocation markedly greater for particles <10 nm diameter. Gold nanoparticles preferentially accumulated in inflammation-rich vascular lesions of fat-fed apolipoproteinE-deficient mice. Furthermore, following inhalation, gold particles could be detected in surgical specimens of carotid artery disease from patients at risk of stroke. Translocation of inhaled nanoparticles into the systemic circulation and accumulation at sites of vascular inflammation provides a direct mechanism that can explain the link between environmental nanoparticles and cardiovascular disease and has major implications for risk management in the use of engineered nanomaterials

Occupational Communication as Boundary Mechanism

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69000/2/10.1177_073088847400100404.pd