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    <recommendedItem id="20100101_19_449"
                     title="FDA Okays Statin for Primary Prevention"
                     score="0.012"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/18380?impressionId=1265801820727"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved rosuvastatin (Crestor) for primary prevention of cardiovascular disease, making it the first statin to receive this indication.&lt;/p&gt;
&lt;p&gt;The new labeling, recommended by an FDA advisory panel late last year, also marks the first time that a drug label will include an indication based on the biomarker highly-sensitive C-reactive protein, an inflammatory marker.&lt;/p&gt;
&lt;p&gt;The new indication would be for men 50 or older and women 60 or older who have fasting LDL of less than 130 mg/dL, a highly-sensitive CRP of 2.0 mg/L or greater, triglycerides of less than 500 mg/dL, and no prior history of heart attack or stroke, or coronary heart disease risk.&lt;/p&gt;
&lt;p&gt;The basis for the new labeling was the JUPITER trial, a randomized, placebo-controlled trial of 17,802 men and women with a mean age of 66 and no history of atherosclerosis. All participants had LDL of less than 130 mg/dL and a highly-sensitive C-reactive protein concentration of 2 mg/L or higher.&lt;/p&gt;
&lt;p&gt;Patients were randomized to 20 mg of rosuvastatin for 1.9 years, which reduced median LDL cholesterol to 55 mg/dL, down from a median of 108 mg/dL at baseline. The corresponding relative reduction in the rate of MI, stroke, arterial revascularization, or cardiovascular death was 44% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.00001).&lt;/p&gt;
&lt;p&gt;The number needed to treat to avoid one cardiovascular event was 25.&lt;/p&gt;
&lt;p&gt;Those results, according to Melvyn Rubenfire, MD, of the University of Michigan, were a &quot;home run for JUPITER,&quot; but it is not clear whether the results would be the same with another statin.&lt;/p&gt;
&lt;p&gt;And there were some risks associated with rosuvastatin, including 13 deaths due to gastrointestinal disorders in the rosuvastatin arm, and 18 patients reported experiencing a &quot;confused state&quot; while taking the drug.&lt;/p&gt;
&lt;p&gt;The most troubling adverse event, however, was an uptick in investigator-reported, new onset diabetes mellitus in the treatment arm, 2.8% versus 2.5%, for a hazard ratio of 1.27 (95% CI 1.05 to 1.53, &lt;em&gt;P&lt;/em&gt;=0.015).&lt;/p&gt;
&lt;p&gt;Rosuvastatin in marketed by AstraZeneca, which also sponsored the JUPITER trial.&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_352"
                     title="ICAO: Future Chronic Disease Risk Goes Beyond BMI (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18233?impressionId=1265801820727"
                     
      When it comes to predicting chronic disease, body mass index doesn&apos;t tell the whole story, according to a population-based study that found elevated risk with obesity and other metabolic risk factors independently.&lt;br&gt;
&lt;br&gt;Metabolically-healthy obese people tended toward being at least twice as likely to develop multiple metabolic risk factors and diabetes as healthy, normal weight individuals over the subsequent 3.5 years of a study led by Sarah Appleton, a postgraduate student at the University of Adelaide, Australia.&lt;br&gt;
&lt;br&gt;However, normal weight individuals with metabolic risk factors  --  a group the researchers called &quot;metabolically obese&quot;  --  were at greater risk, she told attendees at the International Congress on Abdominal Obesity in Hong Kong, a conference sponsored by the International Chair on Cardiometabolic Risk.&lt;br&gt;
&lt;br&gt;Overall, just 4.1% of the 3,743 adults in the population-based, North West Adelaide Health Study were in the normal body mass index range at baseline but had at least two of the following metabolic risk factors:&lt;ul&gt; &lt;li&gt;Triglyceride levels of 1.7 mmol/L or greater&lt;/li&gt; &lt;li&gt;HDL cholesterol under 1.0mmol/L for men or 1.3 mmol/L for women&lt;/li&gt; &lt;li&gt;Blood pressure of 130/85 mm Hg or higher&lt;/li&gt; &lt;li&gt;A fasting plasma glucose of at least 5.6mmol/L or self-reported diabetes&lt;/li&gt; &lt;li&gt;Treatment for any of these disorders &lt;/li&gt; &lt;/ul&gt;
&lt;p&gt;Although free of cardiovascular disease when they entered the study through a random population sample of the northwest region of Adelaide, after a mean of 3.5 years of follow-up, this group was 2.48 times at risk of incident cardiovascular disease or stroke events (95% CI 1.1 to 5.4).&lt;/p&gt;
&lt;p&gt;Compared with metabolically-healthy, normal weight individuals, those with metabolic risk factors tended to be&lt;strong&gt; &lt;/strong&gt;3.27 times as likely to develop diabetes (&lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Identifying these individuals for prevention efforts may require less emphasis on BMI and increased surveillance of central obesity in primary care, the researchers told the congress.&lt;/p&gt;
&lt;p&gt;&quot;The problem with BMI is it doesn&apos;t tell you where the fat is,&quot; Appleton added in an interview. &quot;Visceral fat is really bad for you.&quot;&lt;/p&gt;
&lt;p&gt;Obese individuals without multiple metabolic risk factors at baseline comprised a larger group (12.1%).&lt;/p&gt;
&lt;p&gt;They were more likely to be middle age, live in a disadvantaged neighborhood, have smoked at some point, and get less exercise than their metabolically similar, but slimmer peers.&lt;/p&gt;
&lt;p&gt;Over the subsequent 3.5 years, they were 2.82 times more likely to develop more than one metabolic risk factor than metabolically-healthy, normal weight individuals (95% CI 2.0 to 4.0).&lt;/p&gt;
&lt;p&gt;The metabolically-normal obese also tended to be 2.36 times more likely to develop diabetes (95% CI 0.8 to 7.1). On the other hand, their risk of cardiovascular disease wasn&apos;t elevated, &quot;which likely related to the younger age of that group,&quot; Appleton told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Notably, abdominal obesity as determined by a waist circumference of 80 cm and over for men or 95 cm and greater for women was 6.1 times more likely among metabolically healthy individuals if their BMI was in the obese versus normal range.&lt;/p&gt;
&lt;p&gt;But those who were in the normal BMI range were 2.2-fold more likely to be overweight or obese according to waist circumference if they had metabolic risk factors, which was statistically significant as well and likely contributed to the health risks they faced over the short-term future, Appleton said.&lt;/p&gt;
&lt;p&gt;Maintenance of metabolic health in the obese population was more likely for younger individuals (OR 2.83 for age 40 or younger, 95% CI 1.1 to 7.6) and those who were at least moderately physically active (OR 2.04, 95% CI 1.01 to 4.1).&lt;/p&gt;
&lt;p&gt;Appleton noted that these findings generally fit with data from the U.S. National Health Assessment Survey and Examination.&lt;/p&gt;
&lt;p&gt;Regardless of whether patients have abdominal obesity, BMI obesity, or other metabolic risk factors, the solution is likely similar  --  improved diet and exercise, she 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;The study was supported by the University of Adelaide and the South Australian Department of Health.&lt;/p&gt;&lt;p&gt;Appleton reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_229"
                     title="Abnormal Lipid Levels Common in Teens"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18084?impressionId=1265801820727"
                     
      &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_189"
                     title="Tailoring Trumps Targeting for Cholesterol Control (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18023?impressionId=1265801820727"
                     
      &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_211"
                     title="AHA Sets Sights on &apos;Ideal&apos; Heart Health (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Cardiology/Prevention/tb/18057?impressionId=1265801820727"
                     
      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>
</recommendedContent>
