Edited by J. Michael Gaziano, MD, MPH, and Eric C. Peterson, MD
Atherogenisis by Joshua C. Bird, MS, and Cassio Lynm, MA, CMI. Special thanks to Peter Libby, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, for content review.
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In a randomized trial involving 150 overweight patients with symptomatic atrial fibrillation, Abed and colleagues found that a structured weight management program combined with cardiometabolic risk factor management resulted in greater reduction in atrial fibrillation symptom burden and severity and in more favorable cardiac remodeling than general lifestyle advice and risk factor management.
Low-density lipoprotein cholesterol (LDL-C) concentration is typically estimated with the Friedewald equation, which assumes a fixed ratio of triglycerides to very low-density lipoprotein cholesterol (TG:VLDL-C). Martin and colleagues report the derivation and validation of a novel method for estimating LDL-C, which applies an adjustable factor for the TG:VLDL-C ratio and provides more accurate cardiovascular risk prediction. In an Editorial, Gaziano and Gaziano discuss progress toward accurate characterization of lipid levels.
Transcatheter aortic valve replacement (TAVR) is a recently approved treatment for severe, symptomatic aortic stenosis in high-risk patients. In a review of national registry data from 7710 patients who underwent TAVR, Mack and colleagues found that device success was achieved in 92% of cases, overall in-hospital mortality was 5.5%, and 2% of patients experienced stroke. In an Editorial, Bonow discusses treatment of patients with aortic stenosis.
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In an analysis of data from 369 226 Medicare beneficiaries who underwent aortic valve replacement between 1999 and 2011, Barreto-Filho and colleagues found that the observed rate of aortic valve replacement increased significantly. Rates of aortic valve replacement associated with coronary artery bypass graft surgery and implantation of mechanical prostheses declined, as did age-, sex-, race-, and comorbidity-adjusted rates of 30-day readmission and 30-day and 1-year mortality—although considerable variation in these trends was noted across demographic groups.
The appropriate revascularization modality for patients with advanced coronary disease, diabetes, or left ventricular dysfunction is unclear. To address this question, Deb and colleagues analyzed data from 13 randomized trials and 5 meta-analyses that compared coronary artery bypass graft (CABG) surgery with percutaneous coronary intervention (PCI) procedures for patients with these conditions. The authors report that based on current evidence, CABG is preferred over PCI in patients with advanced left main or multivessel disease, diabetes, or left ventricular dysfunction. For patients with less complicated disease or those who are determined to be at high surgical risk, PCI is preferable.
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