This brief review of recent United States and European guideline recommendations for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) through the management of dyslipidemia/cholesterol compares the evaluation and treatment set forth in both guidelines (see the Table). The US 2018 American Heart Association/American College of Cardiology Multisociety Guideline (AHA/ACC)1 emphasizes

The 2018 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline on the Management of Blood Cholesterol1 divides patients with clinical atherosclerotic cardiovascular disease (ASCVD) into high-risk and very high-risk categories. The high-risk group includes those with stable ASCVD who are treated with high-intensity statins. Very high-risk patients are those with

Sweden has a total population of just >10 million, mostly (85%) in urban areas, and almost one-third with at least one parent born abroad. A mainly publicly financed healthcare system is in place, with low out-of-pocket costs for hospitalizations, procedures, and prescription drugs, also covering treatment that cannot be deferred for asylum seekers and migrants without papers. Medical education in

Background:Whether soy products confer health benefits related to coronary heart disease (CHD) remains controversial because of inconsistent evidence.Methods:A total of 74 241 women from the NHS (Nurses’ Health Study; 1984–2012), 94 233 women from the NHSII (Nurses’ Health Study II; 1991–2013), and 42 226 men from the Health Professionals Follow-Up Study (1986–2012), who were free of cardiovascular

Article, see p 1127 The scientific community has devoted considerable effort in identifying how food and nutrition influence health. In 2019, the key words foods, nutrition, and diet patterns appeared 101 661 times in PubMed—markedly more often than other health behavior–related terms, including physical activity (36 590 records) and sleep (15 018 records). The lay public is eagerly seeking guidance

Background:The COMPASS trial (Cardiovascular Outcomes for People using Anticoagulation Strategies) demonstrated that dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily versus aspirin 100 mg once daily reduced the primary major adverse cardiovascular event (MACE) outcome of cardiovascular death, myocardial infarction, or stroke, as well as, mortality, in

Background:Obesity is strongly associated with exercise intolerance and the development of heart failure. Whereas myocardial energetics and diastolic function are impaired in obesity, systolic function is usually preserved. This suggests that the rate of ATP delivery is maintained, but this has never been explored in human obesity. We hypothesized that ATP transfer rate through creatine kinase (CK)

Article, see p 1152 The human race is dealing with an epidemic of obesity the likes of which has never been seen on planet earth. In the United States alone, the prevalence of obesity is projected to rise to 50% in just 10 years, a staggering increase from 15% in the mid-1970s.1 Obesity is a major risk factor for a number of cardiovascular disorders, including heart failure, and particularly heart

Background: G-protein-coupled receptors (GPCRs) are important regulators of contractility and differentiation in vascular smooth muscle cells (SMC), but the specific function of SMC-expressed orphan GPCR GPRC5B is unclear. Methods: We studied the role of GPRC5B in the regulation of contractility and dedifferentiation in human and murine SMC in vitro as well as in tamoxifen-inducible, SMC-specific knockout

The recent widespread availability and use of mechanical circulatory support is transforming the management and outcomes of cardiogenic shock (CS). Clinical decision-making regarding the optimization of therapies for patients with CS can be guided effectively by hemodynamic monitoring with a pulmonary artery catheter (PAC). Because several studies regarding the benefit of PACs are ambiguous, the use

Women experience a steeper rise in blood pressure than men and this trend begins as early as the third decade of life, suggests a study published in JAMA Cardiology. The results suggest that women may experience more rapid vascular aging, which may make them more vulnerable to cardiovascular risk factors at earlier stages in life, said senior author Susan Cheng, MD, Erika J. Glazer Chair in Women’s

A 59-year-old man with no history of cardiovascular disease was admitted to the emergency department with sudden onset of rapid palpitations and dizziness 2 hours before admission. ECG (Figure 1) revealed a rapid irregular wide QRS complex tachycardia with right bundle-branch block morphology and alternating QRS width. Because the patient was hemodynamically unstable, immediate direct current cardioversion

Parkinson disease (PD) is the second most common neurodegenerative disorder and affects 1% to 3% of people aged >65 years. As life expectancy increases, the prevalence and burden of PD increase worldwide.1 Although epidemiologic studies have consistently reported high PD-associated mortality,2 the relationship between PD and cardiovascular diseases (CVDs), the leading cause of death, remains unclear

Statins prevent cardiac diseases via inhibition of cholesterol biosynthesis and exert pleiotropic effects on the cardiovascular system.1 Statins may also act as antihypertrophic and antiapoptotic agents to prevent cardiomyocyte injury. However, the effects of clinically relevant concentrations of statins (ie, serum peak concentration) on cardiomyocytes remain largely unknown. In the current study,

Background: Apolipoprotein M (APOM) mediates the physical interaction between high-density lipoprotein (HDL) particles and sphingosine-1-phosphate (S1P). APOM exerts anti-inflammatory and cardio-protective effects in animal models.Methods: In a subset of Penn-HF study (PHFS) participants (n=297), we measured APOM by ELISA. We also measured total S1P by liquid chromatography-mass spectrometry and isolated

Background: Recent American College of Cardiology/American Heart Association (ACC/AHA) Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40-70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to

Covid-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint document from representatives of the HRS, ACC and AHA we identify the potential risks of exposure to patients, allied health care staff, industry representatives and hospital administrators

Background: The terminology "end-stage" has been used to describe hypertrophic cardiomyopathy (HCM) with left ventricular systolic dysfunction (herein referred to as HCM-LVSD), defined when left ventricular ejection fraction (LVEF) <50% is present. The prognosis of HCM-LVSD has reportedly been poor, but due to its relative rarity, natural history remains incompletely characterized.Methods: Data from

Background: Non-rheumatic valvular heart diseases (NRVDs) are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease (GBD) 2017 study, mortality, prevalence, and disability-adjusted life years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease (DMVD), and other NRVD were estimated for 195 countries and territories

Background: The relationship between cholesterol levels and risk of venous thromboembolism (VTE) is uncertain. We set out to determine the effect of PCSK9 inhibition on the risk of VTE, explore potential mechanisms, and examine the efficacy in clinically and genetically defined risk subgroups.Methods: We performed a post-hoc analysis of the FOURIER trial testing whether evolocumab reduces the risk

Background: Patients with acute coronary syndrome (ACS) are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C) levels. Our objective was to ascertain whether PCSK9 inhibition reduces the risk of PAD events or VTE after ACS, and if such

Background: In AUGUSTUS, patients with atrial fibrillation (AF) and a recent acute coronary syndrome (ACS) and/or those undergoing percutaneous coronary intervention (PCI) had less bleeding with apixaban than vitamin K antagonist (VKA) and with placebo than aspirin, however, the number of ischemic events was numerically higher with placebo. The aim of this analysis is to assess the tradeoff of risk

Background: Loop diuretics have well described toxicities and loss of response to these agents is common. Alternative strategies are needed for the maintenance of euvolemia in heart failure (HF). Non-renal removal of sodium directly across the peritoneal membrane (direct sodium removal, DSR) using a sodium free osmotic solution should result in extraction of large quantities of sodium with limited

Background: Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implanted cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation

Background: Patients with bicuspid aortic valve (AV) stenosis were excluded from the pivotal evaluations of transcatheter AV replacement (TAVR) devices. We sought to evaluate the outcomes of TAVR in patients with bicuspid AV stenosis compared with those with tricuspid AV. Methods: We used data from the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry

Background: Myocardial infarction (MI) triggers myelopoiesis resulting in heightened production of neutrophils. However, the mechanisms that sustain their production and recruitment to the injured heart are unclear. Methods: Using a mouse model of the permanent ligation of the left anterior descending (LAD) artery and flow cytometry, we first characterized the temporal and spatial effects of MI on

Both insufficient moderate-to-vigorous intensity physical activity (MVPA) and high volumes of sedentary time (ST) have been associated with increased risk of all-cause mortality, cardiovascular disease (CVD), and some cancers.1 However, epidemiological evidence has relied mostly on self-reported physical activity (PA) and ST measures, which are prone to reporting bias and measurement error. Cohort

Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As

Background: Patients with established coronary artery disease (CAD) or peripheral artery disease (PAD) often have diabetes mellitus. These patients are at high risk of future vascular events.Methods: In a prespecified analysis of the COMPASS trial, we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes versus without

Background: Branched-chain amino acids (BCAAs), essential nutrients including leucine, isoleucine and valine, serve as a resource for energy production and the regulator of important nutrient and metabolic signals. Recent studies have suggested that dysfunction of BCAA catabolism is associated with a risk of cardiovascular disease. Platelets play an important role in cardiovascular disease, but the

Recently there have been several high-profile articles in the national media reporting on US congenital heart surgery programs, which have led in part to closure or curtailing of surgical services of at least 5 programs. These articles stemmed from concerns raised by families and practitioners regarding program outcomes and lack of transparency, which led to news media investigations and reported findings

Background: Individuals with carotid stenosis enter surveillance or are considered for surgery based upon disease severity assessed by ultrasound. However, there is variation in the ultrasound diagnostic thresholds used to determine disease severity. Our objective was to describe this variation and its potential impact on patients. Methods: To describe the variation in carotid ultrasound diagnostic

Article, see p 946 Consider the case of C.S., a 69-year-old man who has a moderately severe 50% to 69% left internal carotid stenosis, which has been followed for years by his physician with serial duplex scans at accredited Vascular Laboratory A. When that physician retired, C.S. transitioned his care to another physician, who ordered his annual carotid duplex scan to be performed at accredited Vascular

Background: A "malignant" subphenotype of left ventricular hypertrophy (LVH) has been described, in which minimal elevations in cardiac biomarkers identify individuals with LVH at high risk for developing heart failure (HF). We tested the hypothesis that a higher prevalence of malignant LVH among blacks may contribute to racial disparities in HF risk. Methods: Participants (n=15, 710) without prevalent

Background: Diabetes exacerbates myocardial ischemia/reperfusion (MI/R) injury by incompletely understood mechanisms. Adipocyte dysfunction contributes to remote organ injury. However, the molecular mechanisms linking dysfunctional adipocytes to increased MI/R injury remain unidentified. The current study attempted to clarify whether and how small extracellular vesicles (sEV) may mediate pathological

Background: S-nitrosylation (SNO), a prototypic redox-based posttranslational modification, is involved in the pathogenesis of cardiovascular disease. The aim of this study was to determine the role of S-nitrosylation of muscle LIM protein (MLP) in myocardial hypertrophy, as well as the mechanism by which SNO-MLP modulates hypertrophic growth in response to pressure overload. Methods: Myocardial samples

Heart failure with preserved ejection fraction (HFpEF), a major public health problem that is rising in prevalence, is associated with high morbidity and mortality and is considered to be the greatest unmet need in cardiovascular medicine today because of a general lack of effective treatments. To address this challenging syndrome, the National Heart, Lung, and Blood Institute convened a working group

A 25-year-old man with myotonic muscular dystrophy type 1 presented to the emergency department complaining of palpitations and chest discomfort. A regular wide QRS complex tachycardia with right bundle-branch block (RBBB) morphology (Figure 1) was recorded on electrocardiogram (ECG), being treated with direct electrical cardioversion. An echocardiogram revealed normal biventricular cardiac systolic

Extracorporeal cardiopulmonary resuscitation (ECPR) is expected to benefit the rescue of selected patients, particularly those who are refractory to conventional cardiopulmonary resuscitation (CPR).1 Considering its invasive procedure and considerable resources, establishing a helpful criterion for initiating ECPR remains crucial. Low-flow duration (LFD) is one of the most common criteria to identify

Cardiac cell therapy using adult cells with stem- or progenitor-like properties has been under clinical investigation for more than 15 years. However, the cumulative results from dozens of trials suggest a slight, transient benefit at best.1,2 The underlying rationale for these trials was derived from studies in small and large animals where a more consistent functional benefit has been observed,3

Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation

Background: Pulmonary arterial hypertension (PAH) is a lethal vasculopathy. Hereditary cases are associated with germline mutations in BMPR2 and 16 other genes. However, these mutations occur in under 25% of idiopathic PAH patients (IPAH) and are rare in PAH associated with connective tissue diseases (APAH). Preclinical studies suggest epigenetic dysregulation, including altered DNA methylation, promotes

Background: Spontaneous deep intracerebral hemorrhage (ICH) is a devastating subtype of stroke without specific treatments. It has been thought that smooth muscle cell (SMC) degeneration at the site of arteriolar wall rupture may be sufficient to cause hemorrhage. However, deep ICHs are rare in some aggressive small vessel diseases that are characterized by significant arteriolar SMC degeneration.

Lifetime medication burden from current approaches to LDL-cholesterol (LDL-C) lowering is reliant on small molecules requiring daily dosing with the burden of responsibility placed upon patients. Patient-related factors (risk perception, health literacy) impact adherence and persistence. Adherence to statins and ezetimibe correlate with LDL-C reduction and risk, potentially accounting for approximately

Background: Likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. We aimed to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital

Article, see p 877 Treatment of out-of-hospital cardiac arrest (OHCA) implies a multidisciplinary approach, including the immediate provision of high-quality cardiopulmonary resuscitation, targeted temperature management, consideration of immediate coronary angiography, and early neurological evaluation for prognostication. It is a common condition, with an incidence of 360 000 cases in the United

Background: Long-term outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with a drug-eluting stent are unclear. Therefore, we aimed to evaluate long-term adverse events in HBR patients undergoing PCI with cobalt-chromium (CoCr) everolimus-eluting stent implantation. Methods: We analyzed stratified data from four all-comers post-approval registries.

Background: Diastolic dysfunction is a prevalent and therapeutically intractable feature of heart failure (HF). Increasing ventricular compliance can improve diastolic performance, but the viscoelastic forces that resist diastolic filling and become elevated in human HF are poorly defined. Having recently identified post-translationally detyrosinated microtubules as a source of viscoelasticity in cardiomyocytes

Background: Sphingolipids have recently emerged as a biomarker of recurrence and mortality after myocardial infarction (MI). The increased ceramide levels in mammalian heart tissues during acute MI, as demonstrated by several groups, is associated with higher cell death rates in the left ventricle (LV) and deteriorated cardiac function. Ceramidase, the only enzyme known to hydrolyze pro-apoptotic ceramide

A 51-year-old woman with a medical history of treated primary hypothyroidism was admitted to the emergency department because of a syncopal episode preceded by palpitations with no other prodromal symptoms. The patient experienced occasional episodes of palpitations in the past without loss of consciousness that coincided with febrile episodes and were resolved once the fever was controlled. Upon arrival

Left ventricular assist device (LVAD) implantation is an alternative therapy for end-stage heart failure. Numerous complications are associated with LVADs, including psychiatric disorders such as anxiety and depression. Data regarding the suicide risk in this population are lacking. We aimed at describing the incidence of suicide in LVAD recipients included in the multicenter ASSIST-ICD observational

Antiarrhythmic drugs (AADs) are widely prescribed to treat both ventricular and supraventricular arrhythmias. Although the efficacy of catheter ablation is often superior to AADs, medical rhythm control remains an important treatment modality.1,2 The choice of AAD is affected by efficacy for treatment of the specific arrhythmia, comorbidities including structural heart disease and chronic kidney disease

Increasing evidence demonstrates that perturbation of excitation-contraction coupling in cardiomyocytes leads to cardiac dysfunction and heart failure.1 Critical to excitation-contraction coupling are cardiac dyads, microdomains at membrane contact sites between transverse-tubules and junctional sarcoplasmic reticulum membranes.1,2 Junctophilin 2 (JPH2), spanning the cleft from the transverse-tubule

Sodium-glucose cotransporter 2 inhibitors reduce the risk of serious heart failure and adverse renal events, but the mechanisms that underlie this benefit are not understood. Treatment with SGLT2 inhibitors is distinguished by two intriguing features — ketogenesis and erythrocytosis. Both reflect the induction of a fasting-like and hypoxia-like transcriptional paradigm that is capable of restoring

Background: Compared with the general population, patients with advanced chronic kidney disease (CKD) have a >10-fold higher burden of atrial fibrillation (AF). Limited data are available guiding the use of non-vitamin K antagonist oral anticoagulants in this population.Methods: We compared the safety of apixaban with warfarin in 269 patients with AF and advanced CKD (defined as creatinine clearance

Background: Immune checkpoint inhibitor (ICI) therapy is often accompanied by immune-related pathology, with an increasing occurrence of high-risk ICI-related myocarditis. Understanding the mechanisms involved in this side effect could enable the development of management strategies. In mouse models, immune checkpoints, such as PD-1, control the threshold of self-antigen responses directed against

Background: Brazil, Russia, India, China and South Africa (BRICS) are emerging economies making up almost half the global population. We analyzed trends in cardiovascular disease (CVD) mortality across the BRICS, and associations with age, period and birth cohort. Methods: Mortality estimates were derived from the Global Burden of Disease Study 2017. We used age-period-cohort modeling to estimate cohort

Background: Coconut oil is high in saturated fat and may, therefore, raise serum cholesterol concentrations, but beneficial effects on other cardiovascular risk factors have also been suggested. Therefore, we conducted a systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular risk factors compared with other cooking oils using data from clinical trials. Methods: