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In This Issue of JAMA Cardiology
March 2017


JAMA Cardiol. 2017;2(3):233. doi:10.1001/jamacardio.2016.3634


The aggregate classification of Hispanic, the largest US minority group, may mask heterogeneity in cardiovascular disease (CVD) mortality. Rodriguez and coauthors assessed CVD mortality rates from 2003 to 2012 in Mexican, Puerto Rican, and Cuban individuals from the National Center for Health Statistics. Puerto Rican individuals exhibited similar mortality patterns to non-Hispanic white individuals but higher CVD mortality rates compared with other subgroups. Mexican individuals experienced lower CVD mortality rates but higher cerebrovascular mortality rates. As noted in a commentary by Daviglus, Pirzada, and Stamler, many questions persist about CVD outcomes among diverse Hispanic/Latino groups, including the roles of differential access to care, level of acculturation, and rates of reverse migration.

Invited Commentary

Author Audio Interview

Renal transplantation reduces the risk of myocardial infarction in patients with chronic kidney disease requiring dialysis. Whether transplantation improves ST-elevation myocardial infraction (STEMI) outcomes is uncertain. Gupta and coauthors examined STEMI data from 2003 to 2013 using the National Inpatient Sample database. Risk-adjusted in-hospital mortality was markedly lower in 2980 patients with renal transplants compared with 30 072 patients requiring dialysis but was similar to the 2 319 002 patients without chronic kidney disease. Patients with renal transplants were more likely to receive reperfusion compared with patients requiring dialysis. Although these data are encouraging, in a commentary, Welsh points out the need to improve the disappointing low rates of revascularization in both transplant (62%) and dialysis (37%) groups.

Invited Commentary

Despite the popularity of electronic cigarettes, possible cardiovascular disease risks are uncertain. Moheimani and coauthors investigated the effects of electronic cigarettes on sympathetic activity and markers of oxidative stress. In 23 otherwise healthy habitual electronic cigarette users (aged 21 to 45 years), the high- and low-frequency components of heart rate variability were consistent with sympathetic predominance compared with 19 control patients, and low-density lipoprotein oxidizability, indicative of susceptibility of apolipoprotein-containing lipoproteins to oxidation, was significantly increased. In an editorial, Bhatnagar underscores that it remains unclear to what extent these indirect indices of cardiovascular injury represent an increase in cardiovascular disease risk but also that electronic cigarette use is not without possible health consequences.


Between 1999 and 2010, mean levels of total cholesterol, triglyceride, and low-density lipoprotein cholesterol declined in the United States, regardless of cholesterol-lowering medication use. Rosinger and coauthors used National Health and Nutrition Examination Survey data from 2013 and 2014 in conjunction with data from 1999 to 2012 to determine whether earlier trends continued. Between 1999/2000 and 2013/2014, significant declines in triglyceride and low-density lipoprotein cholesterol levels occurred, with significantly steeper negative slopes between 2011/2012 and 2013/2014. A steady decreasing trend in total cholesterol levels continued in 2013 and 2014. The continued declines of total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels in the US population may be contributing to declining coronary heart disease death rates since 1999.