Missing High Blood Pressure Guideline Turns Up In JAMA Reply

After  years of delay and many twists and turns, the hypertension guideline originally commissioned by the NIH has now finally been published in JAMA. The evidence-based document contains a major revision of hypertension treatment targets and includes new and somewhat simplified recommendations for drug treatment.

The previous US hypertension guideline was published more than a decade ago. After many delays the new guideline was ready for publication earlier this year, but then the NIH decided to get out of the guidelines business. The American Heart Association and the American College of Cardiology assumed responsibility for the development and publication of cardiovascular guidelines and last month published four new cardiovascular guidelines, with the notable exception of the hypertension guideline. As an accompanying JAMA editorial explains:  “Rather than go through an additional review process with the AHA and the ACC the authors decided to publish their guideline in JAMA on their own.”

The big headline of the new guideline is an important change in treatment targets.

Click here to read the full story on Forbes.

Original illustration by Max Husten

Original illustration by Max Husten

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Dispatch From The Wild Frontier Of The Statin Wars Reply

The long simmering controversy over the relative benefits and harms of statins has heated to a high boil with the release of the new AHA/ACC US guidelines. But nowhere is the battle more intense right now than in Australia where, according to the National Heart Foundation, a TV show may be the cause of 2,000 heart attacks and strokes over the next five years.

The show was a 2-part documentary  (click here for part 1 and part 2) broadcast in October on the Australian ABC network about dietary fat and cholesterol.

The program, wrote Amy Corderoy, the health editor of the Sydney Morning Herald, “claimed the causal link between saturated fat, cholesterol and heart disease was ‘the biggest myth in medical history’… [and described statins] as toxic and potentially deadly.”

Catalyst delved into a raging debate: has dietary guidance telling us to avoid fats pushed us towards more harmful sugar and carbohydrates instead?

But the program also went a step further, arguing cholesterol was just an innocent bystander in the body’s attempts to deal with the sugar-damage. It was not a big leap to claim statins were dangerous, and the research supporting them fraudulent.

Click here to read the full post on Forbes.

 

Heart of the Matter screen shot

 

 

FDA Panel Gives Support To Novel Stroke Prevention Device From Boston Scientific Reply

The FDA’s Circulatory System Devices Panel yesterday gave a vote of confidence to Boston Scientific’s Watchman left atrial appendage closure device for the prevention of stroke in atrial fibrillation patients. By a large majority the panel agreed that the device was effective, that it was safe, and that the benefits outweighed the risks. In each case the vote was 13-1.

Click here to read the full story on Forbes.

 

Watchman_2

 

 

 

Should You Be Worried About The Treatment For Low-T? Reply

The ubiquitous ads ask: “Should I be worried about Low-T”? But now there’s a good chance there’s a more important question: “Should I be worried about the treatment for low-T?”

A new study published in JAMA raises the distinct possibility that testosterone therapy may increase the risk of death, heart attack, and stroke. The findings are hardly definitive, but may raise significant questions about the enormous increase in the use of testosterone in recent years, especially  given the absence of any evidence demonstrating the safety of testosterone therapy.

Click here to read the full post on Forbes.

 

 

 

Radiation Dose Linked To Cardiac Risk In Breast Cancer Patients Reply

 

 

In the past, cardiovascular risk has been linked to the radiation dose received by breast cancer patients. Now, a new study published in JAMA Internal Medicine attempts to calculate the cardiac risk of breast cancer patients today undergoing current radiotherapy protocols.

 

David J. Brenner and colleagues calculated the excess cardiac risk for 48 patients who received radiotherapy at New York University. They estimated the 20-year cardiac risk based on baseline risk and patient-specific mean cardiac radiation dose. Cardiac dose was significantly higher in patients with left-sided radiotherapy. These patients also received significantly higher doses if they were treated in the supine body position instead of the prone position. Position did not significantly have an impact on cardiac dose in patients who received right-side radiotherapy.

 

Click here to read the full post on Forbes

 

70. breast cancer radiation http://goo.gl/gsQ8Q

 

Surgery Preferable To Stents In Elderly People With Carotid Disease Reply

Age should play an important role in choosing a revascularization procedure for people with blocked carotid arteries, according to a new paper published in JAMA Surgery.  Carotid endarterectomy surgery (CEA) is preferable to carotid artery stenting (CAS) in elderly people; for younger patients the two revascularization procedures are broadly similar.

George Antoniou and colleagues analyzed data from 44 studies containing more than half a million CEA and 75,000 CAS procedures. In the CAS group, when compared to younger patients elderly patients were at increased risk for stroke (odds ratio 1.56,CI 1.40-1.75). In the CEA group the stroke results were “equivalent” in the older and younger groups (OR 0.94, CI 0.88-0.99). In the CEA group there was a small but statistically significant increase in the mortality rate in the older group compared with the younger group (0.5% versus 0.4%, OR 1.62, CI 1.47-1.77). No significant difference in mortality between the older and younger groups emerged in the CAS group. In both the CAS and the CEA groups, increased age was associated with a greater risk of adverse cardiac events.

Click here to read the full story on Forbes.

 

FDA Approves New Pulmonary Hypertension Drug From Actelion Reply

The FDA today approved macitentan (Opsumit, Actelion), a new oral endothelin-receptor antagonist that is an enhanced version of the company’s bosentan (Tracleer). The drug is indicated to delay disease progression in patients who have pulmonary arterial hypertension (WHO Group I).

Click here to read the full post on Forbes.

 

Actelion

News From Our ‘Statin Civilization': High-Dose Statins Found To Reduce Gum Disease Inflammation Reply

In addition to their well-known benefits in heart disease, high-dose statins appear to reduce gum inflammation caused by periodontal disease, a new report published in the Journal of the American College of Cardiology shows. The findings offer more evidence that heart disease and gum disease may be linked, and also help support the view that statins achieve at least some of their effect not through their cholesterol-lowering effect but through separate inflammation-fighting mechanisms.

Researchers reported findings from 59 patients with cardiovascular disease or at high risk for cardiovascular disease who had evidence  of arterial inflammation on a  PET scan. The patients were randomized to a low (10 mg per day) or high (80 mg per day) dose of atorvastatin. After 12 weeks there was a significant reduction in periodontal inflammation as measured by PET in patients taking high dose atorvastatin. The effect was greatest in those patients who had active periodontal disease. There was evidence of a significant effect as early as 4 weeks. Furthermore, there was a strong correlation between reductions in periodontal inflammation and atherosclerosis, though the authors acknowledged that the precise nature of the association remains undefined.

Click here to read the full story on Forbes.

English: Periodontal bone loss shown in X-Ray ...

Periodontal bone loss shown in X-Ray image. (Photo credit: Wikipedia)

Study Raises Questions About Digoxin Use Today Reply

Digitalis is one of the oldest medicines in the cardiovascular arsenal. When William Withering identified digitalis as the active ingredient in the foxglove plant more than 200 years ago he was only codifying a longstanding folk remedy for heart failure, or “dropsy” as it was known then.

Digitalis fully entered the modern era with the publication of the DIG trial in 1997. The trial found that digitalis reduced hospitalization for heart failure but did not have an impact on mortality. On the basis of the trial digitalis received recommendations in the US and European guidelines for use in patients with systolic heart failure who remain symptomatic despite optimal therapy. However, the epidemiology and treatment of heart failure have evolved considerably since then. Now the authors of a new study, supported by an accompanying editorial, say that these recommendations need to be reconsidered.

In a study published in Circulation: Cardiovascular Quality and Outcomes, James Freeman and colleagues followed 2,891 patients with newly diagnosed systolic heart failure, 18% of whom received digitalis. After 2.5 years the digoxin users had a higher rate of death and hospitalization for heart failure…

Click here to read the full post on Forbes.

 

Clear! CPR in the Hospital Is Not Always Good for the Patient Reply

On TV it always seems clear and simple. A patient in the hospital goes into cardiac arrest and the medical team springs into action. After a few tense moments of furious activity, and only after all seems lost, the patient is successfully revived. A few scenes later the smiling and now fully healthy patient thanks the doctor and returns to his or her life as a professional athlete, parent of young children, or criminal mastermind.

Medical professionals know that in real life this is rarely the way it goes. Most patients who undergo cardiopulmonary resuscitation (CPR) are old, frail, and very sick. Many will die and many who survive CPR will die anyway before leaving the hospital. And many survivors will have severe neurological problems.

Now a physician states in JAMA Internal Medicine that hospitals need to change the way they view CPR.

Click here to read the full story on Forbes.

 

New Test Could Speed Heart Attack Treatment In The Emergency Department Reply

Only 1 in 10 patients with acute chest pain in the emergency department turn out to have an actual heart attack (myocardial infarction), yet many are not released from the hospital until after 6-12 hours of cardiac monitoring and multiple ECG and troponin tests. The search for a test that can rule out MI early in the process has proved elusive.

The Biomarkers in Cardiology-8 (BIC-8) trial, presented at the European Society of Cardiology meeting in Amsterdam, was designed to determine the utility of the combination of troponin and copeptin testing. Copeptin is a marker of severe hemodynamic stress. After an acute MI copeptin levels increase rapidly. In earlier observational studies the combination test was found to have a negative predictive value of 99%.

902 patients with suspected ACS who were troponin negative were randomized to standard treatment or an experimental strategy in which patients with a negative  copeptin test were discharged early. At 30 days there were no significant differences in the rate of major adverse cardiovascular events between the two groups:

Click here to read the full post on Forbes.

 

Kaiser Program Yields Big Improvements In Hypertension Control Reply

A large percentage of the 65 million people with high blood pressure in the United States do not know they have hypertension or have not succeeded in controlling their hypertension. Although many programs have been proposed, there is little evidence that any method can produce long term improvement in hypertension control.

In a paper published in JAMA, researchers at Kaiser Permanente report the outcomes achieved with a large-scale multi-pronged approach to hypertension control. The program included a comprehensive hypertension registry and the development and sharing of performance metrics. Electronic medical records were used to encourage optimal treatment, while patients were offered free medical assistant follow-up visits and simplified medication regimens, including the use of single-pill combination therapy. Physicians were encouraged to use algorithms derived from evolving evidence.

Click here to read the full post on Forbes.

 

Possible Cognitive Benefits Found In Dementia Patients Taking Centrally Acting ACE Inhibitors Reply

An observational study from Ireland raises the intriguing possibility that certain blood pressure lowering drugs, centrally acting ACE inhibitors, may help slow the cognitive decline that is a hallmark of people with Alzheimer’s disease and other forms of dementia.

The study, published in BMJ Open, followed the rates of cognitive decline in 3 groups of patients: dementia patients being treated with centrally acting ACE inhibitors, dementia patients being treated with non-centrally acting ACE inhibitors, and dementia patients newly treated with centrally acting ACE inhibitors.

Click here to read the entire post on Forbes.

 

 

Take Your Blood Pressure Pills Or Increase Your Risk Of Stroke Reply

A large new observational study demonstrates that people who don’t take their antihypertensive medications are much more likely to have a stroke. The new study, published in the European Heart Journal, used nationwide prescription, hospital and mortality records from 73,527 hypertensive patients in Finland.

The Finnish investigators compared 26,704 patients who were hospitalized or died of stroke with 46,823 patients who did not have an event. The stroke patients were older, less educated, had lower income, and were more likely to have diabetes or cancer than controls.

After adjusting for baseline differences between the groups, patients who were non-adherent were two to four times more likely to die from stroke or be hospitalized for stroke than their adherent counterparts.

Click here to read the full story on Forbes.

 

Hypertension And Cholesterol Guidelines Delayed Again As NHLBI Gets Out Of The Guidelines Business Reply

The National Heart, Lung, and Blood Institute (NHLBI) will no longer issue guidelines, including the much-delayed and much-anticipated hypertension (JNC 8) and cholesterol (ATP IV) guidelines. Instead, the NHLBI will perform systematic evidence reviews that other organizations, including the American Heart Association and the American College of Cardiology, will use as a resource for their own guidelines.

The exact fate and form of the delayed hypertension and cholesterol guidelines has not yet been decided, though the NHLBI’s Michael Lauer said he was confident that these guidelines would appear in less than a year. But a lot of work remains before the documents can be published. ACC President John Harold said that  “the ACC has not formally agreed to or begun the process of updating” the NHLBI documents, “but we are open to this role and look forward to working out details with NHLBI and the American Heart Association.”

Click here to read the full story on Forbes.

 

NHLBI Director Dr. Gary Gibbons

NHLBI Director Dr. Gary Gibbons

Unconventional Analysis Finds Threshold For LDL Reduction With Statins Reply

Using an unconventional mathematical approach, a group of Japanese researchers say there may be no good reason to reduce LDL cholesterol more than 40 mg/dl. Their research letter has been published online in JAMA Internal Medicine.

According to the authors, members of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group, most meta-analyses use linear models that assume “a constantly increasing or decreasing risk as the exposure increases or decreases.” Linear models, however, can be “misleading,” they write, because they assume a specific dose-response relationship. By contrast, their new analysis utilizes “flexible” models that can more readily uncover “threshold effects.”

Click here to read the full post on Forbes.

 

Cuban History Offers Important Lessons For Global Health Today 1

A large new study from Cuba shows the impressive benefits that can be achieved with weight loss and increased exercise. Much more ominously, the same study shows the dangers associated with weight gain and less exercise.

In the study, published in BMJ, researchers took advantage of a “natural” experiment that occurred in Cuba as a result of a major economic crisis in the early 1990s. Relying on 30 years of superb health statistics available in the country, the researchers analyzed the dramatic health effects associated with the economic crisis, which last from 1991 through 1995, and the subsequent recovery.

During the economic crisis caloric intake decreased and physical activity increased, resulting in a 5.5 kg reduction in weight and a very high (80%) proportion of the population classified as physically active…

Click here to read the full story on Forbes.

 

 

English: A man fixing the tire of a "Bici...

 

 

Controversial PFO Closure Trials Published In NEJM Reply

Two controversial trials testing PFO closure with the Amplatzer PFO Occluder (St. Jude Medical) in patients with cryptogenic stroke, first presented last fall at the TCT meeting, have now been published in the New England Journal of Medicine. Both trials missed their primary endpoints but contained suggestions of possible benefit. The results appear unlikely to resolve the ongoing controversy over the value, or lack of value, of this procedure, but, as an accompanying editorial states, both advocates and critics of PFO closure will find source material for their arguments in these papers.

In the accompanying editorial, Steven Messé and David Kent write that both trials suffered from slow enrollment, “which was probably due to widespread off-label use of atrial septal closure devices.” They note that RESPECT and PC, like the only other randomized trial in the field, CLOSURE 1, did not show significant benefits in the main intention-to-treat analysis, but did present some evidence of possible benefit.

They conclude:

…we are left for the moment to make decisions under conditions of uncertainty. In such circumstances, evidentiary standards vary among decision makers — patients, clinicians, authors of practice guidelines, and regulatory authorities — depending not only on the interpretation of the results, but also on the potential consequences of their decisions. Some of them may interpret the data as supporting closure of a patent foramen ovale as a viable therapeutic option, even while conceding the failure of trials to show the superiority of closure over medical therapy. Yet given the prevalence of patent foramen ovale in the general population, the enormous potential for overuse of percutaneous closure of a patent foramen ovale, and the relatively low risk of stroke in patients who are treated medically, the routine use of this therapy seems unwise without a clearer view of who, if anyone, is likely to benefit…. Randomized studies of closure may come to an end, however, if the Amplatzer device is approved. Thus, all eyes will be on the regulatory agencies to see how they will interpret these results in light of their own evidentiary standards.

Click here to read the entire story on Forbes.

 

Amplatzer

 

 

 

High Potency Statins Linked To Increased Risk For Acute Kidney Injury Reply

Although the beneficial effects of high-potency statins have been well-characterized in clinical trials, these same trials have lacked the power to illuminate rare but potentially important adverse events. A suggestion of one such area of concern, acute kidney injury, was first raised in the JUPITER trial. Now, a new study published in BMJ provides further information about this area.

Researchers in the Canadian Network for Observational Drug Effect Studies (CNODES) performed a retrospective observational analysis of administrative databases in Canada, the UK and the US containing more than 2 million patients newly treated with statins.  59,636 of the subjects already had chronic kidney disease. One-third of the subjects received high potency statins, defined as ≥10 mg rosuvastatin, ≥20 mg atorvastatin, and ≥40 mg simvastatin.

Within 120 days of starting treatment there were 4691 hospitalizations for acute kidney injury in patients without pre-existing kidney disease and 1896 hospitalizations in patients with pre-existing disease. Patients without pre-existing disease on high potency statins were 34% more likely to be hospitalized with acute kidney injury than patients on other statin regimens. Patients with pre-existing disease did not have a significant increase in risk if they were taking high potency statins.

The authors estimated that 1,700 patients without pre-existing kidney disease would need to be treated with a high potency statin instead of a low potency statin to cause one additional acute kidney injury requiring hospitalization. The findings, according to the authors, are broadly consistent with the JUPITER trial. They write:

Given what is likely to be a small magnitude of incremental cardiovascular benefit of high potency statins over low potency statins in reality, a pressing question is how to identify patients for whom the risk-benefit balance for high potency statin treatment is unfavourable.

In an accompanying editorial, Robert Fassett and Jeff Coombes write that “clinicians should use low potency statins whenever possible to provide cardiovascular benefits without the increased risk of acute kidney injury.” Further, they note, “despite extensive experience with the use of statins over many years, optimization of doses to derive benefit but minimize risk is still evolving.”

Radiotherapy For Breast Cancer Increases Heart Disease Risk 1

A new study published in the New England Journal of Medicine offers the best look yet at the increased risk for heart disease produced by radiotherapy for breast cancer. Further, this increased risk may just be the tip of the iceberg of more radiation-related problems, warns a cardio-oncologist in an accompanying editorial.

The new study, based on data from Sweden and Denmark of women treated with radiotherapy for invasive breast cancer, found a linear increase in the rate of heart disease associated with the dose of radiation received by the heart. Starting 5 years after radiotherapy, and with no sign of a threshold,  the risk for major coronary events increased by 7.4% per gray. The mean dose of radiation was 4 Gy. Although the relative risk was consistent throughout the study, the increase in absolute risk was greatest in women with cardiac risk factors or established heart disease.

Findings from the study, according to the authors, “make it possible to estimate” a patient’s risk for heart disease related to radiation. “This absolute risk can be weighed against the probable absolute reduction in her risk of recurrence or death from breast cancer that would be achieved with radiotherapy.” The authors estimated that for a 50-year-old woman without preexisting risk factors and with a mean radiation exposure of 3 Gy, her risk for death from ischemic heart disease by age 80 would rise from 1.9% to 2.4% and her risk for an acute coronary event would rise from 4.5% to 5.4%. The risk for death by age 80 for an otherwise similar woman with existing risk factors would rise from 3.4% to 4.1%. Women exposed to larger doses of radiation would be exposed to even greater risks.

In the accompanying editorial, Javid Moslehi writes that results of the study suggest that “cardiac risk factors should be assessed and aggressively managed — starting at the time of radiation treatment (or even before) and continuing throughout survivorship.” To make matters worse, the findings “may represent just the tip of the iceberg.” Radiation may also cause increases in pericardial disease, peripheral vascular disease, cardiomyopathy, valvular dysfunction, and arrhythmias, according to Moslehi, and other breast cancer therapies, such as anthracyclines and hormonal therapies, may have “additional cardiotoxic effects.”

Moslehi, who is in the Cardio-Oncology Program at the Dana–Farber Cancer Institute, writes about the emerging new discipline of “cardio-oncology”:

Given the widespread use of radiation therapy in the treatment of breast cancer, and the continually expanding arsenal of novel therapies, the current study calls for greater collaboration between oncologists and cardiologists. An important lesson for the oncologist may be that the time to address concerns about cardiovascular “survivorship” is at the time of cancer diagnosis and before treatment rather than after completion of therapy. Similarly, cardiologists need to assess prior exposure to radiation therapy as a significant cardiovascular risk factor in survivors of breast cancer.

Large Study Finds Genetic Links To Aortic Valve Calcification Reply

A genetic component is believed to play an important role in valvular heart disease, but the specific genes involved have not been identified. Now an interntional group of researchers has identified genetic variations that increase the risk for valvular calcification.

In a paper published in the New England Journal of Medicine, members of the Cohorts for Heart and Aging Research in Genome Epidemiology (CHARGE) consortium report on their search for genes associated with aortic valve calcification and mitral annular calcification in several of study cohorts. They found one SNP, in a gene previously shown to be associated with lipoprotein(a) levels and the risk of coronary artery disease, to be significantly associated with a doubling of the risk for aortic-valve calcification. This finding was replicated in additional cohorts.

Click here to read the full story on Forbes.

Becoming Your Own Doctor In The Brave New World Of Personalized Medicine Reply

Lately there’s been a lot of talk about personalized medicine. There’s a bold idea going around that people should take control of their own healthcare and manage the flood of new data stemming from a whole bunch of new technologies, including, but hardly limited to, personal genomes, biomarkers, wireless sensors, and iPhone ECGs.

Would most should people would benefit if they took a more active role in obtaining this information (for example, by ordering a personal genome from 23andme.com), and then interpreting and acting upon the information?

It seems like a great idea, after all….

…boutique-style healthcare is a lot like organic food, which may taste better and may help a few privileged people feel better about themselves, and may possibly yield a small individual health benefit (though there is absolutely no evidence to show this). However, there is absolutely no chance that organic food can be used to actually feed the vast majority of the 7 billion or so people currently living on this planet.

Similarly, taking control of individual health data will almost certainly allow a few privileged and obsessed people to feel they’re better off than most. It may even improve their health. But, again, more importantly, there is no possibility in the foreseeable future that this self-management of extremely complex personal health data will improve the overall public health of the planet.

Read my entire post on Forbes.

Amgen Trial Fails To Show Benefit Of Anemia Drug In Heart Failure Patients Reply

Deutsch: Amgen als Sponsor der Tour of California

 

The bad news continues for Aranesp (darbepoetin alfa), Amgen’s long-acting erythropoietin-stimulating agent. The drug is intended to stimulate red cell blood production in patients with anemia. Amgen today announced the top line results of a large phase 3 heart failure trial of the drug and said  the trial had failed to meet its primary endpoint.

 

The RED-HF (Reduction of Events With Darbepoetin Alfa in Heart Failure) Trial, which started in 2006, had randomized 2,278 patients with heart failure and anemia to receive either Aranesp or placebo.

 

Click here to read the full story on Forbes.

 

Large Meta-Analysis Finds No Harm Associated With Eggs 2

No food has had more ups and downs over the last century or so than the common egg. Following a long period in which eggs were ubiquitous and highly regarded, eggs fell from favor with the rise of concerns over cholesterol. Currently the American Heart Association recommends that people restrict dietary cholesterol to 300 mg per day, which effectively limits people to 1 egg per day at most. However, the relationship of dietary cholesterol and serum cholesterol  is, at best, tenuous, and a significant number of experts now believe that egg consumption poses no risk to cardiovascular health.

In a new paper published in BMJ, a group of researchers from China and Boston performed a meta-analysis of 8 studies that included 263 938 participants for coronary heart disease (CHD) and 210 404 participants for stroke and followed them for 8 to 22 years. The authors found no evidence for an association between egg consumption and either coronary heart disease or stroke…

Click here to read the full story on Forbes.

Autopsy Studies Find Large And Dramatic Drop In Early Atherosclerosis Over 60 Years 1

Service members who died over the past decade were far less likely to have atherosclerosis than service members who died in Korea or Vietnam, according to a new study published in JAMA. Although it is impossible to fully understand the causes and implications of the finding, the results provide powerful new evidence pointing toward a very long term, enormous reduction in the prevalence of coronary disease, especially in younger people, though an aging population and disturbing trends in obesity and diabetes mean that cardiovascular disease will continue to be a major public health problem for the foreseeable future.

Micrograph of an artery that supplies the hear...

Bryant Webber and colleagues analyzed autopsy reports and available health data from 3,832 service members who died of combat or unintentional injuries in Afghanistan and Iraq and compared their findings to similar studies performed during the Korean and Vietnam wars. 8.5% of the newest group had evidence of coronary atherosclerosis, compared with 77% in the Korean War group and 45% in the Vietnam War group. The authors acknowledge that there are many reasons why the groups should not be directly compared but conclude that the overall trend   in the reduced prevalence of atherosclerosis is undoubtedly true.

As might be expected, service members with atherosclerosis were older and more likely to have dyslipidemia, hypertension, or obesity than service members without atherosclerosis. Surprisingly, cigarette smoking was not significantly associated with atherosclerosis in this study.

In an accompanying editorial, the Framingham Study’s Daniel Levy writes that “the main finding of this study is valid: the prevalence of atherosclerosis in young men today is much lower than the prevalence in the Korean or Vietnam War eras. If these findings are generalizable to the US population as a whole, then the cardiovascular health of the US population may have improved appreciably over the past 6 decades.”

Levy writes that the concurrent decline in mortality from cardiovascular disease is likely the result of advances in both prevention and treatment, but only advances in primary prevention can explain the trend found in the autopsy studies. Nevertheless, he notes, cardiovascular disease is still the leading cause of death in the US: “The national battle against heart disease is not over; increasing rates of obesity and diabetes signal a need to engage earlier and with greater intensity in a campaign of preemption and prevention.”
Click here to read the JAMA press release…