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Perspective
Interpreting the Coronary-Artery Calcium Score
A 55-year-old white man presented with an abnormal coronary-artery calcium (CAC) score. He exercised regularly and was asymptomatic. There was no family history of premature coronary artery disease (CAD). He was not overweight, had never smoked, and did not have diabetes. His blood pressure was 122/…
Original Article
Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors
During the past three decades, the prevalences of overweight and obesity in the pediatric population have increased substantially. Childhood obesity is a predictor of an increased rate of death, owing primarily to an increased risk of cardiovascular disease.– Forecasts suggest that the "obesity…
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- CME
Perspective
The “Million Hearts” Initiative — Preventing Heart Attacks and Strokes
Each year, more than 2 million Americans have a heart attack or stroke, and more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach…
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Review Article
Drug Therapy: n–3 Fatty Acids in Cardiovascular Disease
Cardiovascular disease is the leading cause of death worldwide, and preventive approaches, particularly achievable dietary changes, have major public health implications. An increased dietary intake of n–3 (polyunsaturated) fatty acids is one such dietary approach. This review discusses advances…
Original Article
n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction
A meta-analysis of randomized trials involving patients with cardiac disease showed that supplementation with the marine n−3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduced the rate of death from coronary heart disease by 20%. Mozaffarian and Rimm concluded from…
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Correspondence
24-Hour Ambulatory Blood Pressure in the ACCOMPLISH Trial
To the Editor: Although lowering blood pressure with any effective therapy reduces cardiovascular risk, the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed a 20% greater reduction in cardiovascular events among…
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Perspective
Focus on Research: Coronary Heart Disease and Prevention in the United States
Heart disease remains the leading cause of death in the United States: in 2006, it resulted in 631,636 deaths in this country. Coronary heart disease accounts for 68% of these deaths and affects more than a million Americans each year. Common risk factors for coronary heart disease include…
Clinical Therapeutics
Dietary Therapy in Hypertension
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- CME
A 57-year-old woman is seen in an outpatient clinic, where her blood pressure reading is 155/95 mm Hg. Dietary therapy is recommended. Dietary changes that have been shown to reduce blood pressure include reduced sodium intake, reduced caloric intake (for weight loss), and diets high in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts, and unsaturated vegetable oils.
Original Article
Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus
Diabetes mellitus increases the risk of cardiovascular disease by a factor of two to three at every level of systolic blood pressure. Because cardiovascular risk in patients with diabetes is graded and continuous across the entire range of levels of systolic blood pressure, even at prehypertensive…
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In a randomized trial, 4733 patients with type 2 diabetes mellitus who were at high risk for cardiovascular events received treatment aimed at a target systolic blood pressure of less than 120 mm Hg or less than 140 mm Hg. At a mean follow-up of 4.7 years, the rates of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) were not significantly different between the two trial groups.
Editorial
ACCORD and Risk-Factor Control in Type 2 Diabetes
Patients with type 2 diabetes mellitus without a history of myocardial infarction have the same risk of a coronary event as patients without diabetes who do have a history of myocardial infarction. This observation was part of the basis for the recommendation by the Adult Treatment Panel III (ATP…
Original Article
Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus
Patients with type 2 diabetes mellitus have an increased incidence of atherosclerotic cardiovascular disease.– This increase is attributable, in part, to associated risk factors, including hypertension and dyslipidemia. The latter is characterized by elevated plasma triglyceride levels, low…
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In a randomized trial, 5518 patients with type 2 diabetes mellitus who were at high risk for cardiovascular events were all treated with simvastatin and assigned to receive either fenofibrate or placebo. At a mean follow-up of 4.7 years, the rates of the primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) did not differ significantly between the two study groups.
Original Article
Effect of Nateglinide on the Incidence of Diabetes and Cardiovascular Events
Persons with impaired glucose tolerance are at increased risk for type 2 diabetes mellitus and cardiovascular disease–; therefore, treatments that might reduce the incidence of diabetes and associated cardiovascular disease and death are potentially important. The risk of diabetes is reduced with…
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Among patients with impaired glucose tolerance, the short-acting insulin secretagogue nateglinide did not reduce the incidence of diabetes over the course of 5 years. Nateglinide also did not reduce the risk of cardiovascular events. Therefore, nateglinide does not have a place in the management of impaired glucose tolerance.
Editorial
Navigating the Choices for Diabetes Prevention
The global epidemic of type 2 diabetes has prompted a large number of clinical trials aimed at reducing its incidence. Not surprisingly, addressing the underlying lifestyle behaviors — overeating and inactivity — that result in obesity, the primary cause of the epidemic, has had a major and…
Original Article
Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events
Patients with impaired glucose tolerance have an increased risk of type 2 diabetes mellitus and cardiovascular disease.– Interventions that might reduce the incidence of diabetes and associated rates of death and complications from cardiovascular causes in such patients are therefore of…
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In this large clinical trial, the angiotensin-receptor blocker valsartan reduced the risk of diabetes in patients with impaired glucose tolerance. However, the effect was small, and there was no reduction in the rate of cardiovascular events. Thus, impaired glucose tolerance is probably best managed with lifestyle intervention.
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