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In This Issue of JAMA Cardiology
August 2018


JAMA Cardiol. 2018;3(8):671. doi:10.1001/jamacardio.2017.3376


The association of adverse lifestyle factors with risk of cardiovascular disease (CVD) and diabetes across the spectrum of genetic risk is unknown. Said and coauthors investigated the association of combined health behaviors and factors with incident cardiovascular events and type 2 diabetes within genetic risk groups in 339 003 participants in the UK Biobank cohort study. Genetic risk and lifestyle were independent predictors of incident events. Compared with ideal lifestyle in the low genetic risk group, poor lifestyle was associated with increased risk of incident coronary artery disease, atrial fibrillation, hypertension, stroke, and diabetes in the high genetic risk group.

Discerning genetic and environmental contributions to heart failure (HF) risk is important to further identify individuals at risk. Lindgren and coauthors performed a nationwide adoption study to investigate the heritability of HF in which 21 643 adoptees born in Sweden between 1942 and 1990 were linked to their adoptive parents and biological parents. Adoptees with biological patients with HF had significantly higher risk of developing HF than those without an affected biological parent. The risk associated with HF in an affected adoptive parent was nonsignificant. Increased heritability of HF suggests that genetic factors are important in HF pathogenesis.

Editor’s Note

It is essential to determine whether low-income families are adequately protected from longitudinal health care costs for common chronic conditions. Khera and coauthors examined the burden of total out-of-pocket health expenses among low-income families with a member with atherosclerotic cardiovascular disease (ASCVD). Among 20 600 families in the Medical Expenditure Panel Survey from 2006 through 2015, there were 22 521 adults with ASCVD, corresponding to 9.9% of US adults in 15% of US families. Low-income families had significantly greater risk of catastrophic financial burden than mid/high–income families, representing nearly 2 million low-income families nationally. Even among the insured, 721 000 low-income families (9.8%) experienced catastrophic health care expenses in 2014 and 2015.

The standard Friedewald equation (FE) underestimates low-density lipoprotein cholesterol (LDL-C) levels at lower levels, while the Martin/Hopkins method (MHM) uses a patient-specific conversion factor that provides greater accuracy. Martin and coauthors investigated the accuracy of the FE and MHM compared with criterion standard preparative ultracentrifugation (PUC) in a subset of 12 742 patients enrolled in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk (FOURIER) trial, a randomized clinical trial of evolocumab vs placebo added to statin therapy. In 56 624 observations made when FE indicated an LDL-C level less than 40 mg/dL, differences greater than 10 mg/dL compared with PUC were observed in 2.6% of MHM measurements but in 13.3% of FE measurements, and the correlation with PUC was significantly higher for MHM than FE. In an Invited Commentary, Stone notes that it is timely to consider advantages of MHM, particularly at lower levels of LDL-C.

Invited Commentary

Author Audio Interview