The influence of a social-business diet, comprising high consumption of red meat, pre-made foods, snacks, alcohol and sugary beverages, upon the development of sub-clinical atherosclerotic has not been studied. Data from the Progression of Early Subclinical Atherosclerosis study appear to indicate that such a diet is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis.
PCSK9 inhibitors have been shown to be effective in reducing LDL cholesterol in heterozygous familial hypercholesterolemia and atherosclerotic cardiovascular disease. It has not been confirmed whether such agents provide value for money in an increasingly cash-limited health system. A stimulation model of US adults aged 35-94 years to evaluate the cost-effectiveness of PCSK9 inhibitors or ezetimibe has indicated that based upon 2015 prices PCSK9 inhibitors did not meet the incremental cost effectiveness thresholds, placing a significant increase on the US health care cost.
The target for systolic BP in older adults with hypertension is uncertain. A multicenter randomized study comparing intensive (<120 mmHg) with standard (<140 mmHg) targets in adults ≥ 75 years has indicated that an intensive target is associated with lower rates of fatal and non-fatal major cardiovascular events and mortality. The intensive target was associated with hypotension, syncope, and renal injury.
The effect of the cardiac amyloid light chain (AL) load upon mortality is unknown. In a study of 216 patients with histologically confirmed cardiac amyloidosis, independent predictors of mortality included NYHA class, GFR, responders to chemotherapy and amyloid load. In ATTR amyloidosis, survival correlated with NYHA class, diastolic BP, and use of diuretic agents.
The association between body mass index (BMI) in adolescence and CV death in adulthood has not been adequately addressed. Data from 1967-2010 in 2.3 million Israeli adolescents has demonstrated that BMI in the 50th to 74th percentile, within the accepted normal range, during adolescence is associated with increased risk of CV and all-cause mortality.
Nicole Lou Reporter, MedPage Today/CRTonline.org
J Penalvo, et al.; JACC 2016; 68:805-814
J wing, et al.; Circ 2016; 134:504-513
J Etter, et al.; JACC 2016; 68:777-785
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