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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_348"
                     title="No Rebound Seen After Antiplatelet Withdrawal (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Cardiology/PCI/tb/18226?impressionId=1265737538831"
                     
      &lt;p&gt;No evidence of a platelet aggregation rebound occurs with abrupt discontinuation of clopidogrel (Plavix) in patients undergoing percutaneous coronary intervention (PCI), investigators in a randomized clinical trial concluded.&lt;/p&gt;
&lt;p&gt;Values for adenosine diphosphate (ADP)-induced platelet aggregation did not differ significantly between patients whose clopidogrel therapy was withdrawn abruptly and those in whom clopidogrel was tapered before discontinuation, they wrote in an article in the Feb. 9 issue of the &lt;em&gt;Journal of the American College of Cardiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The findings also showed that tapering of clopidogrel does not lead to lower platelet aggregation values after clopidogrel withdrawal, according to Dirk Sibbing, MD, of Technical University Munich in Germany, and colleagues&lt;em&gt;&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The time course of platelet aggregation values  --  regardless of the device, the agonist, or the agonist concentration used  --  after clopidogrel cessation provides no evidence for the existence of a rebound phenomenon of platelets after discontinuing clopidogrel,&quot; they wrote in conclusion.&lt;/p&gt;
&lt;p&gt;For patients undergoing PCI, dual antiplatelet therapy with aspirin and clopidogrel has become the mainstay for prevention of thrombotic events. Lifelong aspirin therapy is recommended for patients after PCI, but clinical guidelines recommend discontinuation of clopidogrel after six or 12 months. The standard practice is to withdraw clopidogrel abruptly, the authors noted.&lt;/p&gt;
&lt;p&gt;Recent studies have shown a clustering of thrombotic events in the first few weeks after discontinuation of long-term clopidogrel therapy. The observations have led to the hypothesis of a rebound phenomenon of platelet aggregation. However, the hypothesis had not been examined specifically within the context of clopidogrel withdrawal.&lt;/p&gt;
&lt;p&gt;&quot;Because different studies have demonstrated that insufficient suppression of platelet reactivity to ADP is associated with an increased risk of thrombotic events after coronary stent placement, the observed clustering of adverse events reported in clinical studies might be related to an intermittent status of platelet hyperreactivity or so-called platelet rebound with very high ADP-induced platelet aggregation levels,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;A tapering of clopidogrel treatment over a certain period of time before stopping the intake of the drug completely might provide a beneficial treatment strategy to attenuate this supposed rebound phenomenon of platelets.&quot;&lt;/p&gt;
&lt;p&gt;Sibbing and colleagues designed a randomized clinical trial to determine whether a rebound phenomenon exists after discontinuation of clopidogrel and whether the rebound can be attenuated by a clopidogrel-tapering regimen.&lt;/p&gt;
&lt;p&gt;The investigators enrolled 69 patients receiving clopidogrel in association with PCI procedures. In all cases, discontinuation of clopidogrel was planned.&lt;/p&gt;
&lt;p&gt;The patients were randomized to two strategies of discontinuation: tapering of the clopidogrel dose over four weeks, followed by discontinuation; or treatment for four weeks, as planned, followed by abrupt discontinuation.&lt;/p&gt;
&lt;p&gt;Investigators assessed platelet aggregation at enrollment and during weeks two through eight after randomization. Aggregation was assessed simultaneously by light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA).&lt;/p&gt;
&lt;p&gt;The primary endpoint was the highest rate of ADP-induced platelet aggregation by LTA in weeks five through eight after clopidogrel withdrawal.&lt;/p&gt;
&lt;p&gt;Platelet aggregation by LTA peaked at 73% in the group that had clopidogrel abruptly withdrawn and at 69.3% in the tapering group, resulting in a nonsignificant difference (&lt;em&gt;P&lt;/em&gt;=0.21). The between-group values did not differ across the range of ADP concentrations used (1.25 to 20 &amp;#181;mol/L).&lt;/p&gt;
&lt;p&gt;Results by MEA were similar: The peak aggregation value associated with abrupt withdrawal was 925 AU x min compared with 890 AU x min with clopidogrel tapering (&lt;em&gt;P&lt;/em&gt;=0.55).&lt;/p&gt;
&lt;p&gt;Studies with different agonists of platelet aggregation also yielded similar results in the two patient groups.&lt;/p&gt;
&lt;p&gt;Despite finding no difference between the two strategies for clopidogrel withdrawal, the authors did not rule out the possibility of a beneficial effect of tapering clopidogrel.&lt;/p&gt;
&lt;p&gt;&quot;It could be hypothesized that, apart from the maximal values of platelet aggregation observed, a more gradual increase of platelet aggregation values achieved by a clopidogrel-tapering regimen is beneficial for the reduction of thrombotic events,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;In fact, we observed a relatively rapid increase of platelet aggregation values in the [abrupt withdrawal] group of patients in our study. Whether this rapid increase might be disadvantageous in case of stopping clopidogrel treatment remains uncertain.&quot;&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 Cordis, Medtronic, and Dynabyte.&lt;/p&gt;&lt;p&gt;Sibbing disclosed relationships with Dynabyte and Eli Lilly.&lt;/p&gt;&lt;p&gt;Co-author Adnan Kastrati disclosed relationships with Eli Lilly, sanofi-aventis, and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Co-author Nicolas von Beckerath disclosed relationships with Eli Lilly and sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_222"
                     title="Benefits of Cutting Down on Salt Quantified (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/Cardiology/Prevention/tb/18075?impressionId=1265737538831"
                     
      &lt;p&gt;Cutting daily salt intake by 3 grams a day  --  about 30% of the current average  --  could prevent 32,000 strokes and 54,000 myocardial infarctions a year, if a computer model developed by researchers at the University of California, San Francisco accurately depicts the clinical impact of salt reduction.&lt;/p&gt;
&lt;p&gt;The results of the analysis, which used a computer simulation of heart disease in U.S. adults ages 35 to 84, also suggest that even a 1 gram per day reduction in salt over the next decade would be a more cost-effective strategy for treating hypertension than use of even the cheapest antihypertensive, wrote Kirsten Bibbins-Domingo, MD, PhD, and colleagues in a paper published online by the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Lee Goldman, MD, MPH, of Columbia University, who co-authored the paper, told &lt;em&gt;MedPage Today&lt;/em&gt; that their study builds on what has long been known about the adverse health effects of salt on a society that believes it to be the spice of life.&lt;/p&gt;
&lt;p&gt;For example, Goldman said that most people seeking a healthy choice will check food labels and restaurant menus for calorie counts and trans fats, but will not pay attention to salt.&lt;/p&gt;
&lt;p&gt;This is not the first time a call for salt reduction has been issued. As recently as last November, a meta-analysis published in &lt;em&gt;BMJ &lt;/em&gt;suggested that cutting salt intake in half  --  a reduction of about 5 grams a day or roughly a teaspoonful  --  would lower the stroke rate by 23% and reduce overall cardiovascular disease by as much as 17%.&lt;/p&gt;
&lt;p&gt;Americans, like those in many Western countries, take in an average of about 10 g of salt a day; whereas the World Health Organization recommends only 5 g per day, and the U.S. Department of Agriculture recommends daily intake be limited to 5.8 g.&lt;/p&gt;
&lt;p&gt;Bibbins-Domingo and colleagues reported that a 3 gram per day reduction in dietary salt would &quot;save 194,00 to 392,00 quality-adjusted life-years and $10 billion to $24 billion in healthcare costs annually.&quot;&lt;/p&gt;
&lt;p&gt;In an editorial that accompanied the study, Lawrence J. Appel, MD, MPH, and Cheryl A.M. Anderson, PhD, MPH, of Johns Hopkins University, wrote that &quot;the evidence supporting the call to reduce salt intake as a means of preventing cardiovascular disease is compelling.&quot;&lt;/p&gt;
&lt;p&gt;They concluded with this admonition: &quot;As we deliberate healthcare reform, let us not neglect this inexpensive, yet highly effective public health intervention for the prevention of disease.&quot;&lt;/p&gt;
&lt;p&gt;It should be noted that Appel was also first author on a position paper from the American Society of Hypertension that also called for salt reduction as public policy.&lt;/p&gt;
&lt;p&gt;Franz H. Messerli, MD, director of the hypertension program at St. Luke&apos;s-Roosevelt Hospital and a colleague of Goldman&apos;s, said the computer model used in the study was impressive but probably underestimates the benefit of reducing dietary salt &quot;because salt reduction has been shown to have a direct (blood pressure independent) effect on the heart, the brain, the kidneys, and also reduces stomach cancer and osteoporosis  --  factors that were not considered in this analysis.&quot;&lt;/p&gt;
&lt;p&gt;But Messerli found it difficult to lead the victory parade, noting &quot;this is a modeling study and statements such as &apos;A modest reduction of 1 gm per day would be more cost-effective than using medication to lower blood pressure in all persons with hypertension&apos; are to be taken with a good grain of salt.&quot;&lt;/p&gt;
&lt;p&gt;Messerli&apos;s measured response was not echoed by his colleagues in the hypertension world.&lt;/p&gt;
&lt;p&gt;For example, Henry Black, MD, president of the American Society of Hypertension, and director of hypertension research at the New York University School of Medicine said that, although the paper extended the findings of many other studies, it is &quot;more comprehensive and is especially useful by comparing the benefits of [sodium] and [salt] reduction to those of other widely accepted public health approaches that the public and governmental bodies have embraced, including drug treatment.&quot;&lt;/p&gt;
&lt;p&gt;Clyde Yancy, MD, president of the American Heart Association, said that while the study was a computer modeling analysis that may be as good as it gets because &quot;it would be impossible to do a randomized trial in large numbers of high versus low sodium consumption, and the use of modeling with reasonable assumptions represents a solid if not ideal alternative.&quot;&lt;/p&gt;
&lt;p&gt;Moreover, Yancy argued that &quot;the costs and effort involved in setting and/or changing policy&quot; require strong imperatives, and he thought the data reported today &quot;provide that imperative.&quot;&lt;/p&gt;
&lt;p&gt;Three grams of salt comes to about a teaspoonful, but Goldman said it was foolish to think of sodium reduction in terms of such measurements because so much sodium comes from processed foods and from restaurant food. Achieving the needed reduction requires a concerted national effort.&lt;/p&gt;
&lt;p&gt;Bibbins-Domingo noted that their study was limited &quot;by any uncertainty concerning the data entered into the model.&quot;&lt;/p&gt;
&lt;p&gt;Also they noted that they did not &quot;account fully for the possible effects of salt reduction that are unrelated to control of blood pressure  --  for example, potential improvements in outcomes for the increasing numbers of patients with heart failure or prevention of other serious conditions, such as end-stage renal disease.&quot;&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 in part by a grant from the American Heart Association Western States Affiliate and a grant from the University of California, San Francisco Clinical and Translational Sciences Institute.&lt;/p&gt;&lt;p&gt;The authors said they had &quot;no potential conflicts of interest relevant to this article.&quot;&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&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=1265737538831"
                     
      &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_150"
                     title="Circulatory Effects Seen with A-Bomb Radiation (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/tb/17977?impressionId=1265737538831"
                     
      &lt;p&gt;Survivors of the atomic bomb blasts at Hiroshima and Nagasaki have an increased risk of dying from heart disease and stroke, researchers found.&lt;/p&gt;
&lt;p&gt;The estimated excess relative risk per Gy was 9% for stroke and 14% for heart disease (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.02 for both), Yukiko Shimizu, DMSc, of the Radiation Effects Research Foundation in Hiroshima, and colleagues reported online in &lt;em&gt;BMJ&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Significant estimated increases in risk started at doses of 0.5 Gy and higher.&lt;/p&gt;
&lt;p&gt;&quot;The effect of radiation on risk of circulatory disease is potentially a very important public health concern,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;Given the widespread use of multiple computed tomography scans, and other relatively high-dose diagnostic medical procedures, as well as radiotherapy that exposes the heart, the implications are substantial insofar as effects occur at doses under 1 Gy.&quot;&lt;/p&gt;
&lt;p&gt;But they cautioned that &quot;robust confirmatory evidence from other studies is needed.&quot;&lt;/p&gt;
&lt;p&gt;To explore the relationship between radiation exposure and circulatory disease, Shimizu and colleagues looked at more than 50 years of data from the Life Span Study, which has prospectively followed survivors of the atomic bomb blasts in Japan since 1950.&lt;/p&gt;
&lt;p&gt;The analysis included 86,611 individuals who were exposed to radiation at doses ranging from 0 to more than 3 Gy, although 86% received less than 0.2 Gy.&lt;/p&gt;
&lt;p&gt;Through 2003, 9,622 of the participants died from stroke and 8,463 died from heart disease.&lt;/p&gt;
&lt;p&gt;For stroke, a quadratic formula fit the data better than a linear dose-response model, indicating relatively low risk of stroke at lower radiation doses. The linear dose-response model provided the best fit to the data for heart disease, suggesting an excess risk even at lower doses. However, there was not a significant increase in estimated risk for exposures less than 0.5 Gy.&lt;/p&gt;
&lt;p&gt;Adjusting for smoking, alcohol intake, education, occupation, obesity, and diabetes had very little effect on the risk estimates, the researchers wrote.&lt;/p&gt;
&lt;p&gt;To control for the possible misclassification of cancers as circulatory diseases, the researchers re-ran their analysis after excluding those individuals with a history of cancer.&lt;/p&gt;
&lt;p&gt;In this analysis, the excess relative risk for stroke became nonsignificant (&lt;em&gt;P&lt;/em&gt;=0.11), but that for heart disease remained significant (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Mark Little, PhD, of Imperial College London, said the study &quot;adds to a growing body of evidence suggesting an association between cardiovascular disease and exposure to low-moderate levels of radiation, as well as the well-known (and mechanistically well-understood) association at high doses.&quot;&lt;/p&gt;
&lt;p&gt;&quot;However,&quot; he continued, &quot;statistical associations do not prove a causal association, and it is unclear whether the biological mechanisms operating at high doses of radiation apply to low doses.&quot;&lt;/p&gt;
&lt;p&gt;Previous studies, including some randomized controlled trials, have linked high doses of radiation from treatment for Hodgkin&apos;s disease and breast cancer to excess deaths from cardiovascular disease.&lt;/p&gt;
&lt;p&gt;Studies looking at lower doses, however, have yielded mixed results.&lt;/p&gt;
&lt;p&gt;James Thrall, MD, radiologist-in-chief at Massachusetts General Hospital and chair of the American College of Radiology&apos;s board of chancellors, said the results of the current study were not surprising.&lt;/p&gt;
&lt;p&gt;&quot;We have known for a long time that sufficient radiation can have adverse effects on the circulation,&quot; Thrall said in an interview.&lt;/p&gt;
&lt;p&gt;However, he noted that significant associations among the atomic bomb survivors were identified only for doses higher than 0.5 Gy, which is roughly equal to 500 mSv.&lt;/p&gt;
&lt;p&gt;Radiation exposure from typical CT scans ranged from 2 to 31 mSv in a recent study. (See &lt;a href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; mce_href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; target=&quot;_blank&quot;&gt;CT Scans May Deliver Higher-than-Expected Radiation Doses&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Thrall said that risk of circulatory disease is not a consideration when clinicians are weighing the risks and benefits of a CT scan.&lt;/p&gt;
&lt;p&gt;&quot;And I would say that this article does not suggest that that&apos;s a serious concern.&quot;&lt;/p&gt;
&lt;p&gt;The potential mechanisms underlying the association between radiation exposure and circulatory disease remains unclear, but the researchers said &quot;evidence suggests that pro-inflammatory responses to radiation, cellular loss or functional changes in the endothelium, or microvascular damage&quot; may be involved.&lt;/p&gt;
&lt;p&gt;The editorialist Little noted, however, &quot;although we have evidence for [inflammation&apos;s] involvement in the development of cardiovascular disease at high doses of radiation, the mechanism is unclear at low and moderate doses, particularly for occupational exposure, where people receive on average much less than one electron track per cell per day.&quot;&lt;/p&gt;
&lt;p&gt;The study authors noted some limitations of the study: &lt;ul&gt; &lt;li&gt;The ascertainment of circulatory disease from death certificates has limited diagnostic accuracy.&lt;/li&gt; &lt;li&gt;Analyses for potential confounders were incomplete.&lt;/li&gt; &lt;li&gt;There were uncertain associations for exposures below 0.5 Gy.&lt;/li&gt; &lt;li&gt;There is inadequate information about biological mechanisms.&lt;/li&gt; &lt;li&gt;Generalizability to Western populations is uncertain.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Little also pointed to the selection of patients, particularly in the early years of follow-up, as a weakness because these individuals would have been exposed to war and stressful conditions, which increase the risk of cardiovascular disease.&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 Radiation Effects Research Foundation in Hiroshima and Nagasaki is a private nonprofit foundation funded by the Japanese Ministry of Health, Labor, and Welfare and the U.S. Department of Energy, the latter in part through the National Academy of Sciences.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any 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_135"
                     title="Hispanic Groups Differ in Cardiac Conditions (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Cardiology/Atherosclerosis/tb/17952?impressionId=1265737538831"
                     
      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;
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