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In This Issue of JAMA Cardiology
December 2019

Highlights

JAMA Cardiol. 2019;4(12):1187. doi:10.1001/jamacardio.2018.3230

Research

Higher income is associated with lower incident cardiovascular disease (CVD), but the association of changes in income with CVD is uncertain. Wang and coauthors categorized 8989 participants in the Atherosclerosis Risk In Communities (ARIC) study based on whether household income decreased more than 50%, remained unchanged/changed less than 50%, or increased more than 50% over a mean period of 6 years. In adjusted analyses, compared with individuals whose income was unchanged, those with an income drop had higher risk and those with an income rise had lower risk of incident CVD. In an Invited Commentary, Havranek discusses the influence of financial stress on health and the broader question of how physicians should respond to societal problems that lead to illness.

Invited Commentary

Author Audio Interview

Former US football athletes are at increased risk of future cardiovascular morbidity and mortality compared with the general population, but the responsible maladaptive cardiovascular phenotypes have not been fully characterized. Kim and coauthors performed serial evaluations of 126 collegiate US football athletes from 2 National Collegiate Athletic Association Division I programs from freshman year through 3 complete years of US football participation. Adjusting for race, height, and player position, there were significant increases in weight and systolic blood pressure. Weight gain and increases in systolic blood pressure were associated with both arterial stiffening and development of concentric left ventricular hypertrophy.

Guidelines recommend cardiac rehabilitation (CR) after cardiac valve surgery, but few data exist regarding current CR enrollment. Patel and coauthors studied all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014. Among 41 369 beneficiaries undergoing valve surgery, fewer than half (17 855 [43.2%]) enrolled in CR programs. After multivariable adjustment, CR enrollment was associated with fewer hospitalizations within 1 year of discharge and with a 4.2% absolute decrease in 1-year mortality. In an Invited Commentary, Thomas and Brewer comment that as quality improvement practices and coverage policies continue to evolve, more effective and innovative strategies are needed to improve delivery of CR services to all eligible patients.

Invited Commentary

A deceleration in the rate of decrease of heart disease (HD) mortality between 2011 and 2014 has been reported. Using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set, Sidney and coauthors examined changes in the age-adjusted mortality rate and deaths within subcategories of HD from 2011 to 2017 in conjunction with the increase in the US population. The US population 65 years and older increased 22.9% (from 41.4 to 50.9 million), while adults younger than 65 years increased by only 1.7%. Age-adjusted mortality rate decreased 5.0% for HD and 14.9% for coronary HD, while increasing 20.7% for heart failure. The number of deaths increased 8.5% for HD and 38.0% for heart failure, while decreasing 2.5% for coronary HD.

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