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    <recommendedItem id="20100101_19_229"
                     title="Abnormal Lipid Levels Common in Teens"
                     score="0"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18084?impressionId=1265742397676"
                     
      &lt;p&gt;One in five American adolescents has unhealthy cholesterol and triglyceride levels, suggesting that targeted screening of youths would be a good idea, CDC researchers said.&lt;/p&gt;
&lt;p&gt;Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 indicated that 20.3% (95% CI 18.0% to 22.8%) of participants 12 to 19 years old had higher-than-normal levels of LDL cholesterol or triglycerides, or low levels of HDL cholesterol, according to Ashleigh L. May and colleagues at the CDC&apos;s National Center for Chronic Disease Prevention and Health Promotion.&lt;/p&gt;
&lt;p&gt;They also found that about a third of American youths would be candidates for lipid screening on the basis of body mass index (BMI) value, under guidelines from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;Their findings, based on blood tests in 3,125 young NHANES participants, were published in the Jan. 22 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;High LDL cholesterol was defined as at least 130 mg/dL. High triglyceride levels were 150 mg/dL or above. HDL cholesterol of 35 mg/dL or below was considered low. These applied equally across age groups.&lt;/p&gt;
&lt;p&gt;Here is the overall prevalence of each individual lipid abnormality: &lt;ul&gt; &lt;li&gt;High LDL: 7.6% (95% CI 6.2% to 9.3%)&lt;/li&gt; &lt;li&gt;Low HDL: 7.6% (95% CI 6.3% to 9.2%)&lt;/li&gt; &lt;li&gt;High triglycerides: 10.2% (95% CI 8.4% to 12.2%)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Those 18 to 19 years old were much more likely to have these abnormalities than younger adolescents: some 28.8% of participants in this age group had at least one, compared with 16.5% to 18.4% of those 17 and younger (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05).&lt;/p&gt;
&lt;p&gt;Prevalence of lipid abnormalities was also more common among white youths (22.4%) than among black (14.6%) and Hispanic (18.6%) participants (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.05 for both groups versus whites). Girls were somewhat less likely than boys to have one or more abnormalities (prevalence ratio 0.7, 95% CI 0.5 to 0.9).&lt;/p&gt;
&lt;p&gt;Not surprisingly, overweight and obese youths were much more likely than those of normal weight to have unhealthy lipid levels.&lt;/p&gt;
&lt;p&gt;Some 43% of obese adolescents had at least one abnormality, as did 22% of those considered overweight for their age and height. Both were significantly higher than the 14.2% of normal-weight participants with abnormal lipid levels.&lt;/p&gt;
&lt;p&gt;&quot;Based solely on their BMI, 32% of all youths would be candidates for lipid screening,&quot; May and colleagues wrote.&lt;/p&gt;
&lt;p&gt;An unsigned commentary by &lt;em&gt;MMWR&lt;/em&gt;&apos;s editors noted that &quot;untreated abnormal lipid levels in childhood and adolescence are linked to increased risk for cardiovascular disease in adulthood,&quot; but they stopped short of endorsing routine lipid testing for adolescents.&lt;/p&gt;
&lt;p&gt;The American Academy of Pediatrics recommends screening youths with specific risk factors such as overweight and family history. The U.S. Preventive Services Task Force looked at the screening issue in 2007 and decided not to recommend for or against routine screening.&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;MMWR&lt;/em&gt; editors suggested a strategy in line with the pediatrics group&apos;s recommendation. &quot;Targeted screening of youths for abnormal lipid levels can identify those youths who might benefit from interventions that reduce the risk for CVD,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Based on the findings in this study, clinicians should be aware of lipid screening guidelines and recommended interventions for children and youths who are overweight or obese,&quot; the editors added.&lt;/p&gt;
&lt;p&gt;Such interventions include behavior and nutrition counseling and, if lipid levels remain abnormal, drug treatment.&lt;/p&gt;
&lt;p&gt;But the editors pointed out that fewer than 1% of NHANES participants included in the current study &quot;had lipid levels high enough to warrant drug therapy according to AAP guidelines.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_211"
                     title="AHA Sets Sights on &apos;Ideal&apos; Heart Health (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Cardiology/Prevention/tb/18057?impressionId=1265742397676"
                     
      The American Heart Association has launched a national campaign for &quot;ideal&quot; cardiovascular health with an aggressive effort that concentrates on seven health factors and behaviors.&lt;br&gt;
&lt;br&gt;By 2020, the AHA hopes to improve the cardiovascular health of all Americans by 20%, with a corresponding 20% reduction in death from cardiovascular disease and stroke, according to a statement in the Feb. 2 issue of &lt;em&gt;Circulation: Journal of the American Heart Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;If we shift the entire population closer to cardiovascular health, that&apos;s true prevention and that&apos;s going to be incredibly powerful for the long term,&quot; lead author Donald M. Lloyd-Jones, MD, of Chicago&apos;s Northwestern University, said in a prepared statement.&lt;br&gt;
&lt;br&gt;This marks the first time the AHA has made better health a goal in itself, which required new language. Its &quot;ideal&quot; heart health candidates include individuals without clinical cardiovascular disease who: &lt;ul&gt; &lt;li&gt;Never smoked or quit more than one year ago &lt;/li&gt; &lt;li&gt;Maintain a body mass index under 25 kg/m&lt;sup&gt;2&lt;/sup&gt; &lt;/li&gt; &lt;li&gt;Stay physically active for at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity each week &lt;/li&gt; &lt;li&gt;Eat a healthy diet, matching at least four to five of the key dietary components recommended by AHA guidelines, such as low sodium, low sugar-sweetened beverage, high fiber, and fruit and vegetable intake&lt;/li&gt; &lt;li&gt;Keep total cholesterol under 200 mg/dL &lt;/li&gt; &lt;li&gt;Maintain blood pressure below 120/80 mm Hg &lt;/li&gt; &lt;li&gt;Keep fasting blood glucose less than 100 mg/dL&lt;/li&gt; &lt;/ul&gt;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Only about 5% of Americans currently meet these criteria, the organization said.&lt;/p&gt;
&lt;p&gt;The statement also defined intermediate and poor cardiovascular health metrics for adults, as well as appropriate levels for children.&lt;/p&gt;
&lt;p&gt;Rather than rely on medication to achieve these goals, the AHA wants to counsel patients much more intensively on how to maintain cardiovascular health well into middle age, Lloyd-Jones said.&lt;/p&gt;
&lt;p&gt;The association met its prior national goal  --  a 25% reduction in death from heart disease and stroke by 2010  --  two years ahead of schedule, noted Nancy Brown, the association&apos;s CEO.&lt;/p&gt;
&lt;p&gt;But during the same time period, America&apos;s overall health has not improved and probably has gotten worse, with increasing rates of obesity and diabetes, she said in a prepared statement.&lt;/p&gt;
&lt;p&gt;The new goal for 2020 will shape all aspects of the AHA&apos;s efforts over the next decade, according to the statement.&lt;/p&gt;
&lt;p&gt;&quot;We&apos;re going to have much greater focus on public health interventions, changing the environment, changing the nutrition, what food is available, changing the built environment so it&apos;s much easier to participate in physical activity, to keep weight low, and get to middle age with that healthy risk profile,&quot; Lloyd-Jones said in prepared comments.&lt;/p&gt;
&lt;p&gt;When people do reach middle age with a healthy heart, they can look forward to longer life with more healthy years and better health-related quality of life in older age, while society benefits from substantially lower healthcare costs as well, the AHA statement said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Lloyd-Jones reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Coauthors on the guidelines reported financial ties with Abbott Laboratories, Merck/Schering-Plough, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Novartis, Sanofi, Wellpoint, Pfizer, King Pharmaceuticals, the Department of Veterans Affairs, Amgen, Takeda, United Healthcare, Oklahoma Foundation for Medical Quality, American College of Cardiology, Massachusetts Medical Society, American Heart Association, NHLBI, NIDDK, Sigma Tau, Pronova, FDA, United Nations, World Health Organization, UpToDate, International Life Sciences Institute, Aramark, Asmund S. Laerdal Foundation for Acute Medicine, INNERcool, Radiant, Physio-Control, Channing Bete, Forest Pharmaceuticals, Boston Scientific, Insmed, CV Therapeutics, NitroMed, Scios, Mayo Clinic, Texas Medical Center, and Thoratec.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_189"
                     title="Tailoring Trumps Targeting for Cholesterol Control (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18023?impressionId=1265742397676"
                     
      &lt;p&gt;Lipid control is more than a simple matter of &quot;knowing your numbers,&quot; according to a computer model that found tailoring statin therapy to fit an individual&apos;s five-year risk of heart attack or stroke is a better prevention strategy than treating to preset goals.&lt;/p&gt;
&lt;p&gt;In the model, patients who whose five-year coronary artery disease risk was 5% to 15% received 40 mg of simvastatin (Zocor), while those whose risk was greater were given 40 mg of atorvastatin (Lipitor).&lt;/p&gt;
&lt;p&gt;In every scenario, the tailored approach was preferable, Rodney A. Hayward, MD, of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote in the Jan. 19 &lt;em&gt;Annals of Internal Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;While treating-to-target is appealingly simple, that simplicity may be its main limitation, the researchers argued.&lt;/p&gt;
&lt;p&gt;Treating to a single target means that one risk factor receives &quot;dramatically more weight than all other predictors of treatment benefit, resulting in other highly relevant information being either ignored or underweighted,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;That approach, tailoring treatment to reflect multiple risk factors rather than treating-to-target, is an &quot;interesting&quot; one, according to Christopher Cannon, MD, of Brigham and Women&apos;s Hospital in Boston, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;But Cannon, principal investigator of a number of statin trials, said the idea may be a little too late to impact clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;The guidelines won&apos;t shift to this approach any time soon, and in two years, atorvastatin will be generic, so all patients can inexpensively be treated with more intensive therapy (which is better for everyone at all risk levels),&quot; Cannon wrote in an e-mail.&lt;/p&gt;
&lt;p&gt;Although intensive therapy may be better as a rule, he conceded, it&apos;s less cost-effective when an expensive drug is used. When atorvastatin becomes available as a generic, he wrote, for &quot;$4 a month at Walmart it is simply cheaper  --  and of course better  --  to treat everyone with atorvastatin 80 mg.&quot;&lt;/p&gt;
&lt;p&gt;Assuming a population of Americans ages 30 to 75 with no history of myocardial infarction, the authors developed three treatment models: &lt;ul&gt; &lt;li&gt;Standard National Cholesterol Education Program III (NCEP) treat-to-target recommendation, which requires treatment to an LDL target of less than 190 mg/dL for low-risk individuals, less than 160 mg/dL for moderate-risk, and less than 130 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;Intensive NCEP III treat-to-target approach, with targets of less than 100 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;The tailored model, with 40 mg of simvastatin for patients who whose five-year coronary artery disease risk was 5% to 15% and 40 mg of atorvastatin (Lipitor) for higher-risk patients&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;(In both NCEP III strategies statins would be used in a stepwise fashion  --  20 mg simvastatin, 40 mg simvastatin, 40 mg atorvastatin, and, finally, 80 mg atorvastatin  --  to achieve targets).&lt;/p&gt;
&lt;p&gt;Using standard NCEP III treat-to-target recommendations, &quot;37.9 million U.S. persons should receive statins, of which 7.9 million should receive high dose-potency therapy (atorvastatin 40 to 80 mg),&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Compared with no treatment, the standard strategy would save an estimated 48 quality adjusted life years (QALYs) per 1,000 Americans treated for five years, or a total of 1.83 million total QALYs.&lt;/p&gt;
&lt;p&gt;The intensive NCEP III treat-to-target recommendations would &quot;recommend that 53.4 million U.S. persons receive statins&quot; and would save about 570,000 more QALYs than the standard treatment.&lt;/p&gt;
&lt;p&gt;Using the computer model, this strategy prevented &quot;about 720,000 more nonfatal CAD events and 30,000 more deaths&quot; than the standard treatment.&lt;/p&gt;
&lt;p&gt;Tailored treatment, by contrast, would require that about the same number of people receive a statin  --  53 million. But only 13.3 million would require high-dose statin therapy, versus roughly 18 million who would be given high-dose statin therapy using the intensive NCEP III strategy.&lt;/p&gt;
&lt;p&gt;Even so, the tailored approach would save 520,000 more QALYs than the intensive treatment approach, the authors found.&lt;/p&gt;
&lt;p&gt;&quot;The tailored treatment approach was superior to both NCEP III approaches, resulting in both more CAD morbidity and mortality prevented in the overall population and higher treatment efficiency (greater benefit per person treated),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted a number of limitations, including the paucity of clinical trial data on statin therapy in persons ages 75 or older.&lt;/p&gt;
&lt;p&gt;Moreover, although the model suggested a robust benefit for tailored treatment, &quot;the absolute population-level benefit of the tailored treatment over the treat-to-target approaches are much less certain and can vary substantially on the basis of several factors, such as statin&apos;s effect on total mortality (estimates of which are less precise in the literature than estimates for nonfatal CAD events) and the level of treatment adherence that is achievable in real-world clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;Whether a tailored treatment approach is superior for other conditions in which treat-to-target strategies are currently recommended, such as blood pressure and glycemic control, warrants examination,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded in part by the Department of Veteran Affairs Health Services Research &amp;amp; Development Service&apos;s Quality Enhancement Research Initiative.&lt;/p&gt;&lt;p&gt;Hayward did not report any financial disclosures.&lt;/p&gt;&lt;p&gt;Cannon reported receiving research/grants/suport from Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, GlaxoSmithKline, Intekrin Therapeutics, Merck, Merck/Schering-Plough Partnership, Novartis, and Takeda. He is a clinical adviser with equity in Automedics Medical Systems.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_135"
                     title="Hispanic Groups Differ in Cardiac Conditions (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/tb/17952?impressionId=1265742397676"
                     
      Different patterns of left ventricular hypertrophy and ventricular remodeling exist among Hispanic subgroups and in comparison with non-Hispanic whites and blacks, a study found.&lt;br&gt;
&lt;br&gt;After adjustment for hypertension and other variables, Hispanic subgroups had these odds ratios for left ventricular hypertrophy compared with whites, according to an online report in the&lt;em&gt; Journal of the American College of Cardiology:&lt;/em&gt; &lt;ul&gt;&lt;li&gt;Caribbean origin, OR 1.8 (95% CI 1.1 to 3)&lt;/li&gt;&lt;li&gt;Mexican origin, OR 2.2 (95% CI 1.4 to 3.3)&lt;/li&gt;&lt;li&gt;Central/South American origin, OR 1.5 (95% CI 0.7 to 3.1) &lt;/li&gt;&lt;/ul&gt;
All Hispanic subgroups also had a higher prevalence of concentric and eccentric hypertrophy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Carlos J. Rodriguez, MD, of Columbia University in New York, and colleagues wrote.&lt;br&gt;
&lt;br&gt;Some evidence suggests that the prevalence of hypertension differs among Hispanic subgroups, but little is known about the prevalence of left ventricular hypertrophy and remodeling  --  factors that are important for cardiovascular prognosis in a population where heart disease and stroke are the leading causes of death.&lt;/p&gt;
&lt;p&gt;Rodriguez and colleagues therefore analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA) to identify patterns of prevalence, performing cardiac magnetic resonance imaging on 4,309 subjects from six U.S. locations.&lt;/p&gt;
&lt;p&gt;Participants were aged 45 to 84 and all were free of cardiovascular disease at baseline.&lt;/p&gt;
&lt;p&gt;Left ventricular hypertrophy was defined as the upper 95th percentile of indexed left ventricular mass, and left ventricular remodeling was determined by unadjusted left ventricular mass/left ventricular end-diastolic volume ratio.&lt;/p&gt;
&lt;p&gt;Among the 1,064 Hispanics in the cohort, 54% were of Mexican origin, 31% were of Caribbean origin, and 15% were of Central/South American origin.&lt;/p&gt;
&lt;p&gt;Levels of education and income were lower among Hispanics than among either whites or blacks, as was the proportion with private insurance. Among Hispanics, those of Mexican origin had higher mean body mass index and a greater prevalence of diabetes and metabolic syndrome.&lt;/p&gt;
&lt;p&gt;Non-Hispanic blacks had the highest overall prevalence of hypertension, with an unadjusted prevalence ratio of 1.6 compared with non-Hispanic whites.&lt;/p&gt;
&lt;p&gt;Among Hispanics, only those of Caribbean origin had a greater prevalence of hypertension than whites, with an unadjusted prevalence rate of 1.2 (95% CI 1.03 to 1.4).&lt;/p&gt;
&lt;p&gt;After adjustment for multiple factors, including age, sex, body mass index, and diabetes, the prevalence of hypertension remained higher among blacks. But the difference was only of borderline statistical significance for Caribbean-origin Hispanics, at 1.05 (95% CI 1 to 1.10) compared with whites.&lt;/p&gt;
&lt;p&gt;&quot;Despite the modest or absent differences in hypertension prevalence between Hispanics and non-Hispanic whites, all Hispanic subgroups had higher [left ventricular hypertrophy] prevalence than non-Hispanic whites,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;After adjustment for age and sex, Caribbean and Mexican-origin Hispanics had twice the odds of having left ventricular hypertrophy as whites.&lt;/p&gt;
&lt;p&gt;And after adjustment for other variables including body mass index and blood pressure, all Hispanic subgroups had higher percent predicted left ventricular mass than whites.&lt;/p&gt;
&lt;p&gt;Analysis of left ventricular geometry determined that all Hispanic subgroups, and particularly those of Caribbean and Mexican origin, had a greater prevalence (4%) of concentric hypertrophy than whites (1%).&lt;/p&gt;
&lt;p&gt;Concentric hypertrophy tends to be associated with worse target organ damage than either eccentric hypertrophy or concentric remodeling, according to the researchers.&lt;/p&gt;
&lt;p&gt;The finding that Hispanics of Mexican origin had a greater prevalence of left ventricular hypertrophy and left ventricular remodeling despite lower rates of hypertension was &quot;interesting and unexpected,&quot; and may relate to the elevated prevalence rates of obesity, metabolic syndrome, and diabetes in this group, the authors wrote.&lt;/p&gt;
&lt;p&gt;It is also possible that many of the Mexican-origin Hispanics with metabolic syndrome and diabetes had blood pressure higher than 130/80 mm Hg but had not been given a diagnosis of hypertension, and that determinants other than blood pressure, such as psychosocial stress, may contribute to hypertrophy.&lt;/p&gt;
&lt;p&gt;Moreover, this subgroup had significantly lower levels of hypertension treatment (27.5%) than Hispanics of Caribbean origin (38%), which may reflect factors such as access to care or medication adherence.&lt;/p&gt;
&lt;p&gt;Among the limitations of the study was the fact that MESA is not a representative sample of the larger U.S. Hispanic population. It excludes those with prevalent heart disease and therefore represents a lower-risk group.&lt;/p&gt;
&lt;p&gt;The results also may have been limited by residual confounding by body size.&lt;/p&gt;
&lt;p&gt;Nonetheless, the authors concluded that the prevalence of hypertension, left ventricular hypertrophy, and abnormal left ventricular remodeling differ across Hispanic subgroups.&lt;/p&gt;
&lt;p&gt;&quot;Our findings demonstrate that Hispanics are a [cardiovascular] high-risk group and highlight the fact that Hispanics&apos; subgroup differences need to be appreciated when considering [cardiovascular] risk.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Efforts are warranted to better recognize, understand, and address differences among Hispanic ethnic groups to prevent [cardiovascular disease] events in this large subset of the U.S. population,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The research was supported by the National Heart, Lung, and Blood Institute and by a Robert Wood Johnson faculty development program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_5_477"
                     title="Genetic Analysis Predicts Cardiovascular Event Risk"
                     score="-0.005"
                     href="