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In the United States, cardiovascular disease (CVD) burden and risk factors (RFs) at the state level have not been consistently assessed. The Global Burden of Cardiovascular Diseases Collaboration evaluated trends in RFs and lost health due to CVD. From 1990 to 2016, age-standardized CVD disability-adjusted life-years for all states decreased but the rate of decline varied widely, and CVD burden increased for several states in recent years. Prominent RFs driving these trends were dietary risk, hypertension, overweight/obesity, hypercholesterolemia, hyperglycemia, tobacco, and low physical activity levels, with probable unmeasured risk beyond these traditional factors. In an Editorial, Rosamond notes the importance of these benchmarks of persisting disparities in CVD burden, largely attributable to modifiable RFs.
Ticagrelor is recommended after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI), but its safety in patients treated with fibrinolytic therapy is uncertain. Berwanger and coauthors performed a multicenter randomized clinical trial evaluating short-term safety of ticagrelor vs clopidogrel in 3799 patients with STEMI 75 years or younger treated with fibrinolysis. Patients were randomized a median of 11.4 hours after fibrinolysis, and 90% were pretreated with clopidogrel. At 30 days, rates of major bleeding, intracranial bleeding, and fatal bleeding did not differ between patients receiving ticagrelor or clopidogrel, with no difference in the composite of death from vascular causes, myocardial infarction, or stroke (4.0% vs 4.3%, respectively).
Readily accessible means to detect atrial fibrillation (AF) might prevent many strokes. In a proof-of-concept study, Tison and coauthors developed a deep neural network to detect AF using a commercially available smartwatch in a cohort of 9750 individuals, including 347 with AF. Validation in 51 patients with AF undergoing cardioversion yielded high sensitivity (98.0%) and specificity (90.2%). In an exploratory analysis in 183 ambulatory participants, the C statistic was 0.72, the sensitivity was 67.7%, and the specificity was 67.6%. In an Editorial, Turakhia discusses the ongoing innovation and development of such algorithms and their potential for AF screening.
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Thresholds of blood pressure (BP) above which BP accelerates toward established hypertension have not been determined. Niiranen and coauthors performed a longitudinal analysis of 1252 adults enrolled in the Framingham Original Cohort who each contributed up to 28 serial examinations of standardized resting BP measurements between 1948 and 2005. Significant change points were observed in the association between advancing age and increasing systolic BP, but in general a resting systolic BP that chronically exceeded 120 to 125 mm Hg represented a threshold at which rising systolic BP began to accelerate. This may be an important threshold of underlying vascular remodeling that signals incipient hypertension, irrespective of age.
Highlights. JAMA Cardiol. 2018;3(5):361. doi:10.1001/jamacardio.2017.3361