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The Importance of Setting Treatment Goals for Cardiovascular Diseases

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World Journal of Cardiovascular Diseases 2024年第1期14卷 10-15页

作者： David S. Schade Bramara Nagamallika Godasi Teodor Duro robert philip eaton University of New Mexico Health Sciences Albuquerque USA

Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.

关键词： Guideline Goals for Cardiovascular Disease Prevention Cardiovascular Disease Risk Factors for Cardiovascular Disease Pooled Cohort Equations

COVID-19 and Cardiovascular Disease—Two Pandemics, One Success

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World Journal of Cardiovascular Diseases 2023年第4期13卷 236-242页

作者： robert philip eaton Barry Ramo Martin Hickey David S. Schade Division of General Internal Medicine University of New Mexico School of Medicine Albuquerque NM USA New Heart Fitness and Health Albuquerque NM USA New Mexico State Senator Albuquerque NM USA

Background: COVID-19 has had a major impact on all facets of life in the United States. Its devastating effects have resulted in the mobilization of major resources, both at the national, state, and individual levels. This mobilization has resulted in vaccination, personal preventive measures, and new therapies to combat this illness. As a result, the rates of new infections, hospitalizations, and deaths have greatly diminished, minimizing the associated morbidity and mortality. Purpose: What has not been appreciated is that a more serious epidemic has continued unabated in the United States and the Western world. This article emphasizes the importance of a national effort to eradicate cardiovascular disease. Methods: Cardiovascular disease has caused more deaths than COVID-19 in almost all months since the COVID-19 epidemic was first recognized in December 2020. In fact, cardiovascular disease has caused more deaths than either all cancers combined or infections for the last two decades. The tragedy of this truth is that effective therapy is currently available for preventing and reversing cardiovascular disease at a very low cost. What is required is a concerted effort and commitment by all legislative and medical organizations to allocate the resources to abolish asymptomatic cardiovascular disease. Results: Recognition and mobilization of resources to combat this epidemic are much overdue with the resultant savings of lives and billions of dollars. It is past time for the medical establishment to support the national identification of asymptomatic cardiovascular disease and initiate treatment before patients become symptomatic with this deadly disease. Conclusion: The national experience with COVID-19 has demonstrated what can be accomplished when a national concerted effort is made to address a devastating medical epidemic. This commitment is not only feasible for cardiovascular disease, but is also necessary for the benefit of all people in the world.

关键词： Epidemic Cardiovascular COVID-19 Heart Attack Death Rate

Improving Cardiovascular Risk Assessment to Optimize Therapy

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World Journal of Cardiovascular Diseases 2023年第1期13卷 7-20页

作者： Allen Adolphe Shane Wilder Teodor Duro robert philip eaton David S. Schade Division of General Internal Medicine University of New Mexico School of Medicine Albuquerque USA Division of Endocrinology University of New Mexico School of Medicine Albuquerque USA

Background: Quantifying ten-year cardiovascular risk can be challenging. Different online risk calculators provide different risk estimates and online risk calculators use only one point in time. However, risk factors occur over the lifetime of the individual. Purpose: This manuscript provides three solutions to improving ten-year cardiovascular risk assessment in individuals at intermediate risk. Methods: Measuring Lipoprotein(a)—Lp(a) is recommended for assessing cardiovascular risk in all individuals who are in the intermediate risk category by standard online risk calculators. Lp(a) is primarily determined by genetic inheritance. It has the undesirable properties of being proatherosclerotic, proinflammatory, and prothrombotic. Measuring apolipoprotein B (apo B) provides a good index of the number of atherosclerotic particles present. Studies have demonstrated that small, dense LDL cholesterol particles are more atherogenic than larger, less dense LDL cholesterol particles. Measuring high sensitivity C-reactive protein (hsCRP) provides a good estimation of the degree of inflammation in the vascular system. Inflammation is a critical component of heart attacks and strokes. It is increased in diabetes and obesity. Treatment to reduce inflammation results in a reduction of cardiovascular events, independent of lipid values. Results: The above three risk factors should be measured in all patients with an intermediate risk score. Routine assays are readily available at a reasonable cost. They are independent risk factors for cardiovascular disease. Their recommendation is based on the pathophysiology of atherosclerotic cardiovascular disease. Successful therapy will result in the decrease of each of these risk factors. Conclusion: The recommended approach will improve the assessment of cardiovascular risk and guide the physician and patient to the correct treatment recommendations.

关键词： Cardiovascular Disease Atherosclerosis Risk Equations Apolipoprotein B Lipoprotein(a) High Sensitivity C-Reactive Protein

Prevention of Coronary Heart Disease: A Translational Clinical Challenge

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World Journal of Cardiovascular Diseases 2022年第1期12卷 11-23页

作者： Julie Giannini Janae Padilla robert philip eaton Kristen Gonzales David S. Schade Department of Internal Medicine Division of Endocrinology and Metabolism University of New Mexico Health Sciences Center Albuquerque USA

Introduction: Atherosclerotic cardiovascular disease is a dysmetabolic medical condition resulting in the #1 cause of morbidity and mortality in the United States. Coronary Artery Calcium (CAC) CT non-invasively identifies atherosclerosis in asymptomatic individuals. This translational study tested the hypothesis that clinically overtcardiovascular disease can be prevented in asymptomatic individuals in a medical clinic. Methods: Two hundred and six asymptomatic adults requested a CAC scan to identify subclinical heart disease. Individuals with a positive CAC score > 1 (n = 125) were prescribed targeted medical therapy to reverse their atherosclerosis. The goal was to achieve an LDL Cholesterol (LDL-C) ≤ 60 mg/dl. One hundred and ten individuals reached this goal (67 male, 43 female) receiving 10 mg/d of rosuvastatin and 10 mg/d of ezetimibe plus a low cholesterol diet. Other fifteen individuals with positive CAC scores did not achieve this LDL-C goal. Results:

关键词： Asymptomatic Cardiovascular Disease Coronary Artery Calcium Scan Preventive Medical Therapy Cardiovascular Risk

Guidelines for the Prevention of Symptomatic Cardiovascular Disease, Based upon the Presence of Coronary Artery Calcified Plaque—Provided by the Society for the Prevention of Symptomatic Heart Disease

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World Journal of Cardiovascular Diseases 2022年第6期12卷 320-341页

作者： David S. Schade Scott Obenshain Martin Hickey Jennifer Febbo Samuel Wann robert philip eaton University of New Mexico School of Medicine Albuquerque NM USA

Introduction: The epidemic of atherosclerotic cardiovascular disease in the Western World accounts for the majority of morbidity and mortality in adults. This disease is on the increase, and previous recommendations using “risk equations” to prescribe preventive treatment have not been successful in reducing the prevalence of cardiovascular disease. Furthermore, compliance with statin medication has been limited, with approximately 50% of individuals being non-compliant within five years. This situation is unacceptable since atherosclerosis is both preventable and reversible. Methods: The guidelines presented in this article utilize coronary artery calcium scanning as the basis for preventative therapeutic decisions and identifying the presence of asymptomatic cardiovascular disease. This radiographic technique is superior to “risk equations” in predicting future cardiovascular events. It provides a comprehensive assessment of the lifelong insults to the coronary artery vascular endothelium and the resulting inflammation. Coronary artery calcium scanning is widely available, inexpensive, safe, and reproducible. It has the major advantage of increasing treatment compliance in patients with positive coronary artery calcium scores. Results: All suggested guidelines are supported by published scientific data. Citations are provided to allow the reader to obtain further information. The authors are available for further consultation. Each guideline provides specific recommendations that the primary caregiver can discuss with the patient. Patient involvement in decision-making is strongly recommended. Both treatment costs and adverse effects are minimal. Conclusion: It is anticipated that the early identification of asymptomatic cardiovascular disease and its aggressive treatment will result in regression of subclinical atherosclerosis. Adoption of these guidelines will stop the epidemic of symptomatic heart disease and result in healthier and more satisfied patients.

关键词： Symptomatic Cardiovascular Disease Coronary Artery Calcium Scan Myocardial Infarction Cardiovascular Risk Atherosclerosis Risk Equations

Preventing Heart Disease via Coronary Artery Calcium Scoring to Make a Definitive Diagnosis of Atherosclerosis

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World Journal of Cardiovascular Diseases 2022年第10期12卷 457-462页

作者： David S. Schade Samuel Wann Martin Hickey Scott Obenshain Jennifer Febbo robert philip eaton University of New Mexico School of Medicine Albuquerque New Mexico USA

Purpose: Cardiovascular disease is the number one cause of death in the Western world. The purpose of this manuscript is to compare the benefits and deficiencies of coronary artery calcium scanning versus computer generated risk equations in identifying atherosclerotic cardiovascular disease. These two approaches provide significantly different cardiovascular risk assessments and often lead to therapeutic differences in recommendations from the physician to the patient. Methods: Pertinent medical literature is reviewed concerning both risk assessment approaches (i.e., coronary artery scanning and computer generated risk equations). The strengths and weaknesses of both approaches are discussed, and recommendations are provided based upon available data. Results: Cardiovascular risk equations are simple and readily obtained at no charge by physicians. However, their drawbacks are several, including non-applicability to specific populations, disagreements among different cardiovascular society risk equations, wide ranges of risk outputs (e.g., intermediate 10-year risk is between 5% and 20%), inability to definitively identify coronary artery plaques, and lack of definitive anatomical coronary disease. Alternatively, coronary artery calcium scanning costs approximately $100/scan (if not covered by insurance), requires time and effort by the patient, and exposes the patient to a minimal amount of radiation. However, coronary calcium scanning identifies specific atherosclerotic coronary disease and provides additional information about the anatomical location (i.e., coronary artery) of the atherosclerotic plaque. Conclusion: Based on the published literature, coronary artery calcium scanning is the preferred approach for identifying atherosclerotic cardiovascular disease. Although there are minor drawbacks, overall it provides superior clinical information compared with computer generated risk equations.

关键词： Asymptomatic Cardiovascular Disease Coronary Artery Calcium Scan Preventive Medical Therapy Cardiovascular Risk

Lipid nanoparticles deliver mRNA to the blood-brain barrier

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Nano Research 2024年第10期17卷 9126-9134页

作者： Yanina Kuzminich Avraham Shakked Randi Calkins Sebastian Rudden Camille Jones Jessie Doan Bora Jang Elisa Schrader Echeverri Ryan Zenhausern Liming Lian David Loughrey Hannah E.Peck Rachelle Wiese Dorothy Koveal philip J.Santangelo James E.Dahlman George C.Woodruff School of Mechanical Engineering Georgia Institute of TechnologyAtlantaGA 30332USA Parker H.Petit Institute for Bioengineering and Biosciences Georgia Institute of TechnologyAtlantaGA 30332USA Wallace H.Coulter Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of TechnologyAtlantaGA 30332USA

Lipid nanoparticles(LNPs)have delivered RNA to hepatocytes in patients after intravenous *** clinical data support efforts to design LNPs that transfect cells in the central nervous system(CNS).However,delivery to the CNS has been difficult,in large part because quantifying on-target delivery alongside common off-target cell types in adult mice remains *** we report methods to isolate different cell types from the CNS,and subsequently present mRNA delivery readouts using a liver-detargeted *** data suggest that LNPs without targeting ligands can transfect cerebral endothelial cells in mice after intravenous *** the difficulty of crossing the blood-brain barrier,they also underscore the value of quantifying delivery in the CNS with cell-type resolution instead of whole-tissue resolution.

关键词： lipid nanoparticle mRNA nanomedicine central nervous system blood-brain barrier

A Multigrid Method for a Model of the Implicit Immersed Boundary Equations

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Communications in Computational Physics 2012年第7期12卷 378-400页

作者： robert D.Guy Bobby philip Department of Mathematics University of California DavisDavisCA 95616USA Oak Ridge National Laboratory Oak RidgeTN 37831USA

Explicit time stepping schemes for the immersed boundary method require very small time steps in order to maintain *** the equations that arise from an implicit discretization is ***,several different approaches have been proposed,but a complete understanding of this problem is still emerging.A multigrid method is developed and explored for solving the equations in an implicittime discretization of a model of the immersed boundary *** model problem consists of a scalar Poisson equation with conformation-dependent singular forces on an immersed *** model does not include the inertial terms or the incompressibility *** method is more efficient than an explicit method,but the efficiency gain is *** multigrid method alone may not be an effective solver,but when used as a preconditioner for Krylov methods,the speed-up over the explicit-time method is *** example,depending on the constitutive law for the boundary force,with a time step 100 times larger than the explicit method,the implicit method is about 15-100 times more efficient than the explicit method.A very attractive feature of this method is that the efficiency of the multigrid preconditioned Krylov solver is shown to be independent of the number of immersed boundary points.

关键词： Preconditioning implicit methods fluid-structure interaction

Current management of gastro-oesophageal reflux disease—treatment costs,safety profile,and effectiveness:a narrative review

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Gastroenterology Report 2023年第1期11卷 95-113页

作者： Tahmina Lata Jodie Trautman philip Townend robert B.Wilson Faculty of Medicine and Health University of SydneyCamperdownNSWAustralia Upper Gastrointestinal Surgery Department University of New South WalesLiverpool HospitalLiverpoolNSWAustralia General Surgery Department Wollongong HospitalWollongongNSWAustralia General Surgery Department Gold Coast University HospitalSouthportQLDAustralia

Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease(GORD),including treatment costs,safety profile and *** A literature review was performed of randomized-controlled trials,systematic reviews,Cochrane reports and National/Societal guidelines of themedical,endoscopic and surgicalmanagement of *** pump inhibitor(PPI)prescribing patterns and expenditure were reviewed in different countries,including Australia,Canada,New Zealand,UK and *** Proton pump inhibitors(PPIs)are primarily indicated for control of GORD,Helicobacter pylori eradication(combined with antibiotics),preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer *** is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration,with substantial expense for national health *** a favourable short-term safety profile,there are observational associations of adverse effects with long-term *** include nutrient malabsorption,enteric infections and cardiovascular *** prevalence of PPI use makes their long-termsafety profile clinically ***-benefit,symptom control and quality-oflife outcomes favour laparoscopic fundoplication rather than chronic PPI *** fundoplication in long-termmanagement of PPI-responsive GORD is supported by SAGES,NICE and ACG,and PPI-refractory GORD by AGA and SAGES *** importance of establishing a definitive diagnosis prior to invasive management is emphasized,especially in PPI-refractory *** We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health *** narrative review presents the advantages and disadvantages of surgical,endoscopic and medical management of GORD,which may assist in shared decision making and treatment cho

关键词： Canada treatment establishing