by 2007, LDL levels in patients with pro-gression were approximately half as highas in earlier years and were actually lowerthan LDL levels in patients with regression.
The rationale for this treatment paradigmis that, as the authors put it, “treating ar-teries without measuring plaque would belike treating hypertension without meas-uring blood pressure.” In this single-centerstudy, treatment based on carotid totalplaque area led to a substantial increase inplaque regression as compared with treat-ment based on lipid levels. However, theseresults must be tested in a large randomizedtrial with hard clinical outcomes before amajor shift in clinical practice can berecommended.
— Joel M. Gore, MD
Spence JD and Hackam DG. Treating arteries in-stead of risk factors: A paradigm change in manage-ment of atherosclerosis.
2010 Jun; 41:1193.
Stroke Risk Grows withWaistlines in U.S. Women
Rising obesity is associated with rising midlife stroke rates in women, but not in men.
Recent research has demonstrated thatthe prevalence of stroke in women aged45 to 54 is twice that in men of similar age(
2007; 69:1898). Investigatorssought to determine whether this observedsex difference is a recent phenomenon, andif so, whether it could relate to worseningof vascular risk factors or increases in bio-marker levels among women. They evalu-ated medical histories and biomarkerdata from participants in the NationalHealth and Nutrition Examination Survey (NHANES) 1988–1994 compared withanalogous data from NHANES 1999–2004. In all, 9706 women and men aged35 to 54 answered the question about priordiagnosis of stroke.In women, stroke prevalence increasedfrom 0.6% in 1988–1994 to 1.8% 1999–2004; no such increase was seen in men(0.9% and 1.0% in 1988–1994 and 1999–2004, respectively). The percentage of women with abdominal obesity (defined aswaist circumference >88 cm [34.6 inches])increased from 47% to 59% between thetwo survey periods; average waist circum-ference in women was nearly 4 cm (1.6inches) greater in 1999–2004 than in1988–1994. In contrast, most key biomarkerlevels and traditional vascular risk factorsremained stable or even improved inwomen, with the exception of glycemicmarkers and luteinizing hormone levels,which increased substantially between thetwo survey periods.
NHANES data reveal that midlife strokerates have tripled among U.S. women dur-ing the past two decades. These results in-dicate that risk for stroke between the agesof 35 and 54 is higher in women than inmen and compellingly suggest that obesity and metabolic syndrome (reflected by gly-cemic markers and luteinizing hormonelevels) are driving much of the increase.Further longitudinal studies are requiredto illuminate trends in stroke incidenceand to explore associated factors moreclosely.
— JoAnne M. Foody, MD
Towfighi A et al. Weight of the obesity epidemic:Rising stroke rates among middle-aged women inthe United States.
2010 May 27; [e-pubahead of print]. (http://dx.doi.org/10.1161/ STROKEAHA.109.577510)
Hamburgers, Hot Dogs,and Heart Health
In a meta-analysis, processed meat con- ferred higher risks for CAD and diabetesthan unprocessed red meat.
We make dietary choices and recommen-dations with less-than-complete evidenceto guide us. A current controversy con-cerns the effects of meat, particularly redand processed meats, on cardiovascularrisk. These investigators conducted a sys-tematic review and meta-analysis of stud-ies evaluating the associations between redand processed meat consumption and risksfor coronary heart disease (CHD), stroke,and diabetes.The researchers did not identify any trials; their analysis included 17 prospectivecohort studies and 3 case-control studies.Consumption of unprocessed red meat wasnot associated with CHD (4 studies; rela-tive risk, 1.00 per 100-g serving/day; 95%confidence interval, 0.81–1.23) or diabetes(5 studies; RR, 1.16; 95% CI, 0.92–1.46).Consumption of processed meat was asso-ciated with a 42% increase in risk for CHD(5 studies; RR, 1.42 per 50-g serving/day;95% CI, 1.07–1.89) and a 19% increase inrisk for diabetes (7 studies; RR, 1.19; 95%
Harlan M. Krumholz, MD, SM,
Harold H. Hines, Jr.,Professor of Medicine, Section of CardiovascularMedicine, Yale University School of Medicine,New Haven
Kristin L. Odmark
Massachusetts Medical Society
Howard C. Herrmann, MD,
Professor of Medicine,Director, Interventional Cardiology and CardiacCatheterization Laboratories, University ofPennsylvania Medical Center, Philadelphia
JoAnne M. Foody, MD,
Director, CardiovascularWellness Center, Brigham and Women’s Hospital,Boston
Joel M. Gore, MD,
Edward Budnitz Professorof Cardiovascular Medicine, University ofMassachusetts, Worcester
Mark S. Link, MD,
Associate Professor of Medicine,New England Medical Center and Tufts UniversitySchool of Medicine, Boston
Frederick A. Masoudi, MD, MSPH,
Division ofCardiology, Denver Health Medical Center andAssociate Professor of Medicine, University ofColorado at Denver
Beat J. Meyer, MD,
Associate Professor ofCardiology, University of Bern; Chief, Division ofCardiology, Lindenhofspital, Bern, Switzerland
William T. Abraham, MD,
Professor of Medicine,Chief, Division of Cardiovascular Medicine,The Ohio State University Heart Center, Columbus
Hugh Calkins, MD,
Professor of Medicine andDirector of Electrophysiology, The Johns HopkinsHospital, Baltimore
Kim A. Eagle, MD,
Albion Walter Hewlett Professorof Internal Medicine and Chief of ClinicalCardiology, Division of Cardiology, University ofMichigan Medical Center, Ann Arbor
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Vol. 16 No. 7