The new heart failure: A call for new research initiatives

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Walking around the Cardiac Intensive Care Unit (CICU) with one of my heart failure colleagues, I was struck by the relative absence of patients with acute myocardial infarctions. Over the past 50 years, they have been replaced by patients with advanced heart failure, many of whom had been implanted with left ventricular assist devices or connected to a variety of extracorporeal support devices.

Although some of the patients were new New York Heart Association class IV patients, many had been treated for years with beta-blockers and renal ACE inhibitors or aldosterone antagonists. Their disease had now recurred and progressed despite what I had presumed to be curative drug therapy. They were experiencing the relentless progression of heart failure despite treatment that was developed almost 20 years ago and which has not advanced much since then. Many cardiologists of my generation presumed that heart failure was no longer a problem even though we knew that annual mortality rates of heart failure remained in the 10% range and that its incidence was increasing.

It has become clear to many of us that there has been little advance in the treatment of heart failure since the introduction of those 20th century drugs, notwithstanding the importance of the development of end stage cardiac support devices.

It seems our success in treating patients with ischemic heart disease had only delayed the expression and progression of cardiac dysfunction. Even with our success in treating patients with nonischemic heart failure, whatever that is, after reaching a brief plateau with drug therapy, they often experienced recurrence. It is true that many patients had improved as a result of drug therapy and that progression had been arrested and in some patients heart failure had actually been reversed. But many, like the patients I saw in our CICU, had progressed to advanced heart failure with little to be offered other than end-stage device therapy or heart transplantation. Both of these outcomes, although lifesaving, represent therapeutic failures.

It is time that we refocus our efforts on the treatment and eradication of heart failure. Although a number of contemporary treatment strategies have been developed, for the most part they have only resulted in modest additive benefit. We need to reconsider the protection of the heart during and after an ischemic event and prevent the insidious progression of ischemia in those patients with chronic coronary heart disease. In addition we need to direct our research to understand the pathophysiology of the “heart” in heart failure and to unlock the mysticism associated with the many etiologies of idiopathic nonischemic heart failure. Our knowledge in this disease or diseases is embarrassingly poor.

It is time to move on from the 20th century drug foundation of therapy based on neurohumoral control, to a 21st century understanding of the cellular and molecular targets affecting cardiac function. Recent investigations of collagen synthesis and degradation, cardiac energetics, and mitochondrial function have provided provocative information but represent only forays into the vast unknown mechanism of heart failure. The solution to worldwide heart failure is not in device therapy for everyone but in a deeper understanding of the mechanisms of heart failure and its application to therapy.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

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Walking around the Cardiac Intensive Care Unit (CICU) with one of my heart failure colleagues, I was struck by the relative absence of patients with acute myocardial infarctions. Over the past 50 years, they have been replaced by patients with advanced heart failure, many of whom had been implanted with left ventricular assist devices or connected to a variety of extracorporeal support devices.

Although some of the patients were new New York Heart Association class IV patients, many had been treated for years with beta-blockers and renal ACE inhibitors or aldosterone antagonists. Their disease had now recurred and progressed despite what I had presumed to be curative drug therapy. They were experiencing the relentless progression of heart failure despite treatment that was developed almost 20 years ago and which has not advanced much since then. Many cardiologists of my generation presumed that heart failure was no longer a problem even though we knew that annual mortality rates of heart failure remained in the 10% range and that its incidence was increasing.

It has become clear to many of us that there has been little advance in the treatment of heart failure since the introduction of those 20th century drugs, notwithstanding the importance of the development of end stage cardiac support devices.

It seems our success in treating patients with ischemic heart disease had only delayed the expression and progression of cardiac dysfunction. Even with our success in treating patients with nonischemic heart failure, whatever that is, after reaching a brief plateau with drug therapy, they often experienced recurrence. It is true that many patients had improved as a result of drug therapy and that progression had been arrested and in some patients heart failure had actually been reversed. But many, like the patients I saw in our CICU, had progressed to advanced heart failure with little to be offered other than end-stage device therapy or heart transplantation. Both of these outcomes, although lifesaving, represent therapeutic failures.

It is time that we refocus our efforts on the treatment and eradication of heart failure. Although a number of contemporary treatment strategies have been developed, for the most part they have only resulted in modest additive benefit. We need to reconsider the protection of the heart during and after an ischemic event and prevent the insidious progression of ischemia in those patients with chronic coronary heart disease. In addition we need to direct our research to understand the pathophysiology of the “heart” in heart failure and to unlock the mysticism associated with the many etiologies of idiopathic nonischemic heart failure. Our knowledge in this disease or diseases is embarrassingly poor.

It is time to move on from the 20th century drug foundation of therapy based on neurohumoral control, to a 21st century understanding of the cellular and molecular targets affecting cardiac function. Recent investigations of collagen synthesis and degradation, cardiac energetics, and mitochondrial function have provided provocative information but represent only forays into the vast unknown mechanism of heart failure. The solution to worldwide heart failure is not in device therapy for everyone but in a deeper understanding of the mechanisms of heart failure and its application to therapy.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

Walking around the Cardiac Intensive Care Unit (CICU) with one of my heart failure colleagues, I was struck by the relative absence of patients with acute myocardial infarctions. Over the past 50 years, they have been replaced by patients with advanced heart failure, many of whom had been implanted with left ventricular assist devices or connected to a variety of extracorporeal support devices.

Although some of the patients were new New York Heart Association class IV patients, many had been treated for years with beta-blockers and renal ACE inhibitors or aldosterone antagonists. Their disease had now recurred and progressed despite what I had presumed to be curative drug therapy. They were experiencing the relentless progression of heart failure despite treatment that was developed almost 20 years ago and which has not advanced much since then. Many cardiologists of my generation presumed that heart failure was no longer a problem even though we knew that annual mortality rates of heart failure remained in the 10% range and that its incidence was increasing.

It has become clear to many of us that there has been little advance in the treatment of heart failure since the introduction of those 20th century drugs, notwithstanding the importance of the development of end stage cardiac support devices.

It seems our success in treating patients with ischemic heart disease had only delayed the expression and progression of cardiac dysfunction. Even with our success in treating patients with nonischemic heart failure, whatever that is, after reaching a brief plateau with drug therapy, they often experienced recurrence. It is true that many patients had improved as a result of drug therapy and that progression had been arrested and in some patients heart failure had actually been reversed. But many, like the patients I saw in our CICU, had progressed to advanced heart failure with little to be offered other than end-stage device therapy or heart transplantation. Both of these outcomes, although lifesaving, represent therapeutic failures.

It is time that we refocus our efforts on the treatment and eradication of heart failure. Although a number of contemporary treatment strategies have been developed, for the most part they have only resulted in modest additive benefit. We need to reconsider the protection of the heart during and after an ischemic event and prevent the insidious progression of ischemia in those patients with chronic coronary heart disease. In addition we need to direct our research to understand the pathophysiology of the “heart” in heart failure and to unlock the mysticism associated with the many etiologies of idiopathic nonischemic heart failure. Our knowledge in this disease or diseases is embarrassingly poor.

It is time to move on from the 20th century drug foundation of therapy based on neurohumoral control, to a 21st century understanding of the cellular and molecular targets affecting cardiac function. Recent investigations of collagen synthesis and degradation, cardiac energetics, and mitochondrial function have provided provocative information but represent only forays into the vast unknown mechanism of heart failure. The solution to worldwide heart failure is not in device therapy for everyone but in a deeper understanding of the mechanisms of heart failure and its application to therapy.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

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VIDEO: Moderate LDL, SBP reductions slash cardiovascular events 90% over time

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ROME – Combined exposure to low LDL cholesterol and systolic blood pressure is associated with multiplicative and cumulative effects over time, Brian A. Ference, MD, said in a video interview at the annual congress of the European Society of Cardiology.

Indeed, long-term exposure to a combined 1-mmol/L lower LDL cholesterol and 10-mm Hg lower systolic BP was associated with up to a 90% lower risk of major cardiovascular events in the “naturally randomized” study he presented. The investigators used the 102,000 participants’ genetic LDL and BP scores in a Mendelian design.

If these lower LDL and blood pressure levels are sustained over decades, “those cumulative effects multiply, resulting in potentially dramatic reductions in the lifetime risk of cardiovascular events from even modestly lower levels of LDL and systolic blood pressure,” Dr. Ference of Wayne State University, Detroit, told reporter Bruce Jancin.

 

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

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ROME – Combined exposure to low LDL cholesterol and systolic blood pressure is associated with multiplicative and cumulative effects over time, Brian A. Ference, MD, said in a video interview at the annual congress of the European Society of Cardiology.

Indeed, long-term exposure to a combined 1-mmol/L lower LDL cholesterol and 10-mm Hg lower systolic BP was associated with up to a 90% lower risk of major cardiovascular events in the “naturally randomized” study he presented. The investigators used the 102,000 participants’ genetic LDL and BP scores in a Mendelian design.

If these lower LDL and blood pressure levels are sustained over decades, “those cumulative effects multiply, resulting in potentially dramatic reductions in the lifetime risk of cardiovascular events from even modestly lower levels of LDL and systolic blood pressure,” Dr. Ference of Wayne State University, Detroit, told reporter Bruce Jancin.

 

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

[email protected]

ROME – Combined exposure to low LDL cholesterol and systolic blood pressure is associated with multiplicative and cumulative effects over time, Brian A. Ference, MD, said in a video interview at the annual congress of the European Society of Cardiology.

Indeed, long-term exposure to a combined 1-mmol/L lower LDL cholesterol and 10-mm Hg lower systolic BP was associated with up to a 90% lower risk of major cardiovascular events in the “naturally randomized” study he presented. The investigators used the 102,000 participants’ genetic LDL and BP scores in a Mendelian design.

If these lower LDL and blood pressure levels are sustained over decades, “those cumulative effects multiply, resulting in potentially dramatic reductions in the lifetime risk of cardiovascular events from even modestly lower levels of LDL and systolic blood pressure,” Dr. Ference of Wayne State University, Detroit, told reporter Bruce Jancin.

 

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

[email protected]

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AT THE ESC CONGRESS 2016

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Zika outbreak forces better history taking, tracking

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ANNAPOLIS, MD. – The definition of taking a thorough travel history has expanded with the spread of Zika.

Physicians “need to focus not only on patients’ travel histories, but also the travel histories and future travel plans of our patients’ sexual partners,” Ilona T. Goldfarb, a perinatologist at Massachusetts General Hospital, Boston, said in an interview. “We cannot rely on our patients to just [offer] that they’ve been in the Caribbean. We have to ask them diligently, and at every visit.”

 

Dr. Ilona T. Goldfarb

Dr. Goldfarb added that immigration is a risk for Zika exposure, and may be a barrier to accurate history taking. In these cases, travel history will need to be performed in the patient’s spoken language to ensure accuracy, Dr. Goldfarb said. To track and communicate Zika information, Dr. Goldfarb and her colleagues have developed a three-part response based on their experience with previous infectious disease emergencies:

1. Communication. The practice is in regular communication with the Centers for Disease Control and Prevention and the state public health department to ensure they are up to date on all guidelines.

2. Education. Dr. Goldfarb and her practice colleagues routinely brief each other and patients on any new information, including recommended testing and guidelines, as well as travel warnings.

3. Tracking. Clinicians use a tracking worksheet for every patient screened for potential Zika exposure, allowing them to prospectively and retrospectively review patients. This has already proven useful, Dr. Goldfarb said, when the CDC changed its guidance around testing of asymptomatic patients.

In a presentation at the annual scientific meeting of the Infectious Diseases Society for Obstetrics and Gynecology, Dr. Goldfarb presented the data that she and her colleagues have collected so far on patients with Zika exposure.

As of Aug. 10, 2016, the practice had screened 142 women for Zika virus exposure since January 2016. More than 80% of the exposure came from travel to Zika-endemic areas. There have been few cases of exposure reported through sex, but Dr. Goldfarb said she thinks this type of exposure has been underreported because the link between infection and sex was not known until more recently.

Of the patients screened, 87% were appropriate candidates for Zika virus serum testing under CDC guidelines. There have been four positive serum tests for Zika exposure in Dr. Goldfarb’s patients so far.

In the one live birth, the newborn showed no visible signs of abnormalities. Testing revealed Zika virus RNA in the placenta, but not in the cord blood. The other three pregnancies were either terminated or associated with miscarriages. Again, Zika was detected in the placentas, but not in the fetuses.

Testing protocols have been a moving target since the outbreak began, according to Dr. Goldfarb. Some patients who call or are screened for possible exposure “are not actually eligible for testing because of the time frame or location of travel.”

To make sure that appropriate testing is being performed, Dr. Goldfarb advised designating an in-practice “Zika expert.” In her own practice, Dr. Goldfarb and one other colleague handle all Zika screening and inquiries from patients and colleagues. “This has greatly improved our efficiency and the experience for the patients,” she said in an interview.

The Massachusetts Department of Public Health is piloting a program with Dr. Goldfarb’s practice to determine if using the “designated expert” approach will improve laboratory wait times, compared with the standard protocol of having clinicians obtain approval from a state epidemiologist before sending patient serum samples for testing.

It has taken from 2 to 68 days to receive test results from the state lab, although a period of 17 days is typical, Dr. Goldfarb reported. The process has improved since last March when state health officials ramped up their capacity, she said.

As of Aug. 10, Dr. Goldfarb’s practice has performed 107 ultrasounds for patients with suspected Zika virus, averaging 3 per patient. Across all ultrasounds, there were three abnormalities, including one case of bilateral ventriculomegaly. Earlier in that pregnancy, the patient had tested negative for Zika on real-time reverse transcription polymerase chain reaction testing, which simultaneously screens for dengue, chikungunya, and Zika. Serum testing was also negative for Zika in the two other pregnancies with fetal abnormalities.

Dr. Goldfarb said she couldn’t quantify how much time is being spent on Zika screening and counseling since that is not being tracked, but she estimated that her practice takes between three and five calls or questions per day regarding the virus.

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ANNAPOLIS, MD. – The definition of taking a thorough travel history has expanded with the spread of Zika.

Physicians “need to focus not only on patients’ travel histories, but also the travel histories and future travel plans of our patients’ sexual partners,” Ilona T. Goldfarb, a perinatologist at Massachusetts General Hospital, Boston, said in an interview. “We cannot rely on our patients to just [offer] that they’ve been in the Caribbean. We have to ask them diligently, and at every visit.”

 

Dr. Ilona T. Goldfarb

Dr. Goldfarb added that immigration is a risk for Zika exposure, and may be a barrier to accurate history taking. In these cases, travel history will need to be performed in the patient’s spoken language to ensure accuracy, Dr. Goldfarb said. To track and communicate Zika information, Dr. Goldfarb and her colleagues have developed a three-part response based on their experience with previous infectious disease emergencies:

1. Communication. The practice is in regular communication with the Centers for Disease Control and Prevention and the state public health department to ensure they are up to date on all guidelines.

2. Education. Dr. Goldfarb and her practice colleagues routinely brief each other and patients on any new information, including recommended testing and guidelines, as well as travel warnings.

3. Tracking. Clinicians use a tracking worksheet for every patient screened for potential Zika exposure, allowing them to prospectively and retrospectively review patients. This has already proven useful, Dr. Goldfarb said, when the CDC changed its guidance around testing of asymptomatic patients.

In a presentation at the annual scientific meeting of the Infectious Diseases Society for Obstetrics and Gynecology, Dr. Goldfarb presented the data that she and her colleagues have collected so far on patients with Zika exposure.

As of Aug. 10, 2016, the practice had screened 142 women for Zika virus exposure since January 2016. More than 80% of the exposure came from travel to Zika-endemic areas. There have been few cases of exposure reported through sex, but Dr. Goldfarb said she thinks this type of exposure has been underreported because the link between infection and sex was not known until more recently.

Of the patients screened, 87% were appropriate candidates for Zika virus serum testing under CDC guidelines. There have been four positive serum tests for Zika exposure in Dr. Goldfarb’s patients so far.

In the one live birth, the newborn showed no visible signs of abnormalities. Testing revealed Zika virus RNA in the placenta, but not in the cord blood. The other three pregnancies were either terminated or associated with miscarriages. Again, Zika was detected in the placentas, but not in the fetuses.

Testing protocols have been a moving target since the outbreak began, according to Dr. Goldfarb. Some patients who call or are screened for possible exposure “are not actually eligible for testing because of the time frame or location of travel.”

To make sure that appropriate testing is being performed, Dr. Goldfarb advised designating an in-practice “Zika expert.” In her own practice, Dr. Goldfarb and one other colleague handle all Zika screening and inquiries from patients and colleagues. “This has greatly improved our efficiency and the experience for the patients,” she said in an interview.

The Massachusetts Department of Public Health is piloting a program with Dr. Goldfarb’s practice to determine if using the “designated expert” approach will improve laboratory wait times, compared with the standard protocol of having clinicians obtain approval from a state epidemiologist before sending patient serum samples for testing.

It has taken from 2 to 68 days to receive test results from the state lab, although a period of 17 days is typical, Dr. Goldfarb reported. The process has improved since last March when state health officials ramped up their capacity, she said.

As of Aug. 10, Dr. Goldfarb’s practice has performed 107 ultrasounds for patients with suspected Zika virus, averaging 3 per patient. Across all ultrasounds, there were three abnormalities, including one case of bilateral ventriculomegaly. Earlier in that pregnancy, the patient had tested negative for Zika on real-time reverse transcription polymerase chain reaction testing, which simultaneously screens for dengue, chikungunya, and Zika. Serum testing was also negative for Zika in the two other pregnancies with fetal abnormalities.

Dr. Goldfarb said she couldn’t quantify how much time is being spent on Zika screening and counseling since that is not being tracked, but she estimated that her practice takes between three and five calls or questions per day regarding the virus.

[email protected]

On Twitter @whitneymcknight

ANNAPOLIS, MD. – The definition of taking a thorough travel history has expanded with the spread of Zika.

Physicians “need to focus not only on patients’ travel histories, but also the travel histories and future travel plans of our patients’ sexual partners,” Ilona T. Goldfarb, a perinatologist at Massachusetts General Hospital, Boston, said in an interview. “We cannot rely on our patients to just [offer] that they’ve been in the Caribbean. We have to ask them diligently, and at every visit.”

 

Dr. Ilona T. Goldfarb

Dr. Goldfarb added that immigration is a risk for Zika exposure, and may be a barrier to accurate history taking. In these cases, travel history will need to be performed in the patient’s spoken language to ensure accuracy, Dr. Goldfarb said. To track and communicate Zika information, Dr. Goldfarb and her colleagues have developed a three-part response based on their experience with previous infectious disease emergencies:

1. Communication. The practice is in regular communication with the Centers for Disease Control and Prevention and the state public health department to ensure they are up to date on all guidelines.

2. Education. Dr. Goldfarb and her practice colleagues routinely brief each other and patients on any new information, including recommended testing and guidelines, as well as travel warnings.

3. Tracking. Clinicians use a tracking worksheet for every patient screened for potential Zika exposure, allowing them to prospectively and retrospectively review patients. This has already proven useful, Dr. Goldfarb said, when the CDC changed its guidance around testing of asymptomatic patients.

In a presentation at the annual scientific meeting of the Infectious Diseases Society for Obstetrics and Gynecology, Dr. Goldfarb presented the data that she and her colleagues have collected so far on patients with Zika exposure.

As of Aug. 10, 2016, the practice had screened 142 women for Zika virus exposure since January 2016. More than 80% of the exposure came from travel to Zika-endemic areas. There have been few cases of exposure reported through sex, but Dr. Goldfarb said she thinks this type of exposure has been underreported because the link between infection and sex was not known until more recently.

Of the patients screened, 87% were appropriate candidates for Zika virus serum testing under CDC guidelines. There have been four positive serum tests for Zika exposure in Dr. Goldfarb’s patients so far.

In the one live birth, the newborn showed no visible signs of abnormalities. Testing revealed Zika virus RNA in the placenta, but not in the cord blood. The other three pregnancies were either terminated or associated with miscarriages. Again, Zika was detected in the placentas, but not in the fetuses.

Testing protocols have been a moving target since the outbreak began, according to Dr. Goldfarb. Some patients who call or are screened for possible exposure “are not actually eligible for testing because of the time frame or location of travel.”

To make sure that appropriate testing is being performed, Dr. Goldfarb advised designating an in-practice “Zika expert.” In her own practice, Dr. Goldfarb and one other colleague handle all Zika screening and inquiries from patients and colleagues. “This has greatly improved our efficiency and the experience for the patients,” she said in an interview.

The Massachusetts Department of Public Health is piloting a program with Dr. Goldfarb’s practice to determine if using the “designated expert” approach will improve laboratory wait times, compared with the standard protocol of having clinicians obtain approval from a state epidemiologist before sending patient serum samples for testing.

It has taken from 2 to 68 days to receive test results from the state lab, although a period of 17 days is typical, Dr. Goldfarb reported. The process has improved since last March when state health officials ramped up their capacity, she said.

As of Aug. 10, Dr. Goldfarb’s practice has performed 107 ultrasounds for patients with suspected Zika virus, averaging 3 per patient. Across all ultrasounds, there were three abnormalities, including one case of bilateral ventriculomegaly. Earlier in that pregnancy, the patient had tested negative for Zika on real-time reverse transcription polymerase chain reaction testing, which simultaneously screens for dengue, chikungunya, and Zika. Serum testing was also negative for Zika in the two other pregnancies with fetal abnormalities.

Dr. Goldfarb said she couldn’t quantify how much time is being spent on Zika screening and counseling since that is not being tracked, but she estimated that her practice takes between three and five calls or questions per day regarding the virus.

[email protected]

On Twitter @whitneymcknight

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Request for Applications for JVS Editorial Positions

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The editors of the Journal of Vascular Surgery Publications are seeking nominations, including self-nominations, for multiple editorial positions. All applicants must be active or senior members of the Society for Vascular Surgery. Prior service on the JVS editorial board is preferred. An annual financial stipend is provided for these editorial roles.

More information about each of the positions listed below can be found in this online document.

Assistant editor of abstracts and book reviews. This editor selects non-JVS abstracts and writes short commentaries for those abstracts for publication in the JVS and JVS-VL. This editor will also write and solicit book reviews.

Assistant editor of social media and press releases. This position requires writing short press release articles for the JVS Journals and drafting Facebook, Twitter and LinkedIn posts to promote JVS content.

Assistant editor of reviews for the Journal of Vascular Surgery. The assistant editor solicits review articles and manages the peer-review process for systematic reviews, meta-analyses, and evidence summaries.

Associate basic science editor for the JVS and the JVSVL. This associate editor manages the peer-review process and makes the final decision on manuscript publication for about 200 basic science submissions a year.

Associate editor of the Journal of Vascular Surgery. The JVS associate editor manages the peer-review process of about 600 submissions a year, recommending a final decision to the editors regarding the publication of a submission.

If you would like to apply for one of these editorial positions, please send your name and a brief summary of your qualifications Jessica McEwan, JVS managing editor at: [email protected]. The deadline for applications is Oct. 1, 2016.

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The editors of the Journal of Vascular Surgery Publications are seeking nominations, including self-nominations, for multiple editorial positions. All applicants must be active or senior members of the Society for Vascular Surgery. Prior service on the JVS editorial board is preferred. An annual financial stipend is provided for these editorial roles.

More information about each of the positions listed below can be found in this online document.

Assistant editor of abstracts and book reviews. This editor selects non-JVS abstracts and writes short commentaries for those abstracts for publication in the JVS and JVS-VL. This editor will also write and solicit book reviews.

Assistant editor of social media and press releases. This position requires writing short press release articles for the JVS Journals and drafting Facebook, Twitter and LinkedIn posts to promote JVS content.

Assistant editor of reviews for the Journal of Vascular Surgery. The assistant editor solicits review articles and manages the peer-review process for systematic reviews, meta-analyses, and evidence summaries.

Associate basic science editor for the JVS and the JVSVL. This associate editor manages the peer-review process and makes the final decision on manuscript publication for about 200 basic science submissions a year.

Associate editor of the Journal of Vascular Surgery. The JVS associate editor manages the peer-review process of about 600 submissions a year, recommending a final decision to the editors regarding the publication of a submission.

If you would like to apply for one of these editorial positions, please send your name and a brief summary of your qualifications Jessica McEwan, JVS managing editor at: [email protected]. The deadline for applications is Oct. 1, 2016.

The editors of the Journal of Vascular Surgery Publications are seeking nominations, including self-nominations, for multiple editorial positions. All applicants must be active or senior members of the Society for Vascular Surgery. Prior service on the JVS editorial board is preferred. An annual financial stipend is provided for these editorial roles.

More information about each of the positions listed below can be found in this online document.

Assistant editor of abstracts and book reviews. This editor selects non-JVS abstracts and writes short commentaries for those abstracts for publication in the JVS and JVS-VL. This editor will also write and solicit book reviews.

Assistant editor of social media and press releases. This position requires writing short press release articles for the JVS Journals and drafting Facebook, Twitter and LinkedIn posts to promote JVS content.

Assistant editor of reviews for the Journal of Vascular Surgery. The assistant editor solicits review articles and manages the peer-review process for systematic reviews, meta-analyses, and evidence summaries.

Associate basic science editor for the JVS and the JVSVL. This associate editor manages the peer-review process and makes the final decision on manuscript publication for about 200 basic science submissions a year.

Associate editor of the Journal of Vascular Surgery. The JVS associate editor manages the peer-review process of about 600 submissions a year, recommending a final decision to the editors regarding the publication of a submission.

If you would like to apply for one of these editorial positions, please send your name and a brief summary of your qualifications Jessica McEwan, JVS managing editor at: [email protected]. The deadline for applications is Oct. 1, 2016.

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All SVS members may submit proposals for invited sessions for the 2017 Vascular Annual Meeting, set for May 31 to June 3 (plenaries and exhibits are June 1 to 3) in San Diego, Calif.

Previously, the process was open only to SVS committees; planners opened the process to all members this year, with any and all ideas for sessions to be reviewed for further development.

Invited sessions include postgraduate courses, breakfast and concurrent sessions and workshops. Initial submissions are due Sept. 16. Learn more here.

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All SVS members may submit proposals for invited sessions for the 2017 Vascular Annual Meeting, set for May 31 to June 3 (plenaries and exhibits are June 1 to 3) in San Diego, Calif.

Previously, the process was open only to SVS committees; planners opened the process to all members this year, with any and all ideas for sessions to be reviewed for further development.

Invited sessions include postgraduate courses, breakfast and concurrent sessions and workshops. Initial submissions are due Sept. 16. Learn more here.

All SVS members may submit proposals for invited sessions for the 2017 Vascular Annual Meeting, set for May 31 to June 3 (plenaries and exhibits are June 1 to 3) in San Diego, Calif.

Previously, the process was open only to SVS committees; planners opened the process to all members this year, with any and all ideas for sessions to be reviewed for further development.

Invited sessions include postgraduate courses, breakfast and concurrent sessions and workshops. Initial submissions are due Sept. 16. Learn more here.

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VIDEO: PCSK9 inhibitor can nearly replace need for apheresis in HeFH

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VIDEO: PCSK9 inhibitor can nearly replace need for apheresis in HeFH

ROME – Treating patients with heterozygous familial hypercholesterolemia (HeFH) with PCSK9 inhibitors can reduce their need for lipoprotein apheresis and its associated costs, Patrick M. Moriarty, MD, said in a video interview at the annual congress of the European Society of Cardiology.

In the randomized, phase III ODYSSEY ESCAPE trial, HeFH patients who underwent weekly apheresis were treated with either alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, or placebo. At the end of the study, the alirocumab-treated patients had a 75% greater reduction in need for apheresis, compared with those on placebo – a statistically significant difference.

With a price tag of $50,000-$75,000 a year for lipoprotein apheresis, compared with the roughly $12,000 cost for a PCSK9 inhibitor, this represents a significant savings for patients with HeFH, which occurs in roughly 1 in 200 people worldwide, Dr. Moriarty of the University of Kansas, Kansas City, told reporter Bruce Jancin.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

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ROME – Treating patients with heterozygous familial hypercholesterolemia (HeFH) with PCSK9 inhibitors can reduce their need for lipoprotein apheresis and its associated costs, Patrick M. Moriarty, MD, said in a video interview at the annual congress of the European Society of Cardiology.

In the randomized, phase III ODYSSEY ESCAPE trial, HeFH patients who underwent weekly apheresis were treated with either alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, or placebo. At the end of the study, the alirocumab-treated patients had a 75% greater reduction in need for apheresis, compared with those on placebo – a statistically significant difference.

With a price tag of $50,000-$75,000 a year for lipoprotein apheresis, compared with the roughly $12,000 cost for a PCSK9 inhibitor, this represents a significant savings for patients with HeFH, which occurs in roughly 1 in 200 people worldwide, Dr. Moriarty of the University of Kansas, Kansas City, told reporter Bruce Jancin.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

[email protected]

ROME – Treating patients with heterozygous familial hypercholesterolemia (HeFH) with PCSK9 inhibitors can reduce their need for lipoprotein apheresis and its associated costs, Patrick M. Moriarty, MD, said in a video interview at the annual congress of the European Society of Cardiology.

In the randomized, phase III ODYSSEY ESCAPE trial, HeFH patients who underwent weekly apheresis were treated with either alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, or placebo. At the end of the study, the alirocumab-treated patients had a 75% greater reduction in need for apheresis, compared with those on placebo – a statistically significant difference.

With a price tag of $50,000-$75,000 a year for lipoprotein apheresis, compared with the roughly $12,000 cost for a PCSK9 inhibitor, this represents a significant savings for patients with HeFH, which occurs in roughly 1 in 200 people worldwide, Dr. Moriarty of the University of Kansas, Kansas City, told reporter Bruce Jancin.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

[email protected]

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VIDEO: PCSK9 inhibitor can nearly replace need for apheresis in HeFH
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AT THE ESC CONGRESS 2016

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First TOS Reporting Standards Published

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First TOS Reporting Standards Published

SVS members now have access to the first-ever reporting standards for Thoracic Outlet Syndrome, published in the September issue (online) at the Journal of Vascular Surgery. Drs. Karl Illig and Audra Duncan led the TOS Reporting Standards Writing Group, which worked for three years to create the reporting standards. The group hopes that with unified data collection, practice guidelines can follow in five to 10 years.

Access the reporting standards here.

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SVS members now have access to the first-ever reporting standards for Thoracic Outlet Syndrome, published in the September issue (online) at the Journal of Vascular Surgery. Drs. Karl Illig and Audra Duncan led the TOS Reporting Standards Writing Group, which worked for three years to create the reporting standards. The group hopes that with unified data collection, practice guidelines can follow in five to 10 years.

Access the reporting standards here.

SVS members now have access to the first-ever reporting standards for Thoracic Outlet Syndrome, published in the September issue (online) at the Journal of Vascular Surgery. Drs. Karl Illig and Audra Duncan led the TOS Reporting Standards Writing Group, which worked for three years to create the reporting standards. The group hopes that with unified data collection, practice guidelines can follow in five to 10 years.

Access the reporting standards here.

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Review Course Recordings Available

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Review Course Recordings Available

Just in time for the September recertification exam! Recordings of the 2015 Comprehensive Vascular Review Course are available for purchase.

The 2015 intensive two-day course was led by vascular surgeons with extensive expertise in their respective fields. The recordings include didactic lectures and review of essential VESAP questions.

The recordings also provide a comprehensive update in all areas of vascular surgery. No CME credit is available.

Purchase the recordings here.

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Just in time for the September recertification exam! Recordings of the 2015 Comprehensive Vascular Review Course are available for purchase.

The 2015 intensive two-day course was led by vascular surgeons with extensive expertise in their respective fields. The recordings include didactic lectures and review of essential VESAP questions.

The recordings also provide a comprehensive update in all areas of vascular surgery. No CME credit is available.

Purchase the recordings here.

Just in time for the September recertification exam! Recordings of the 2015 Comprehensive Vascular Review Course are available for purchase.

The 2015 intensive two-day course was led by vascular surgeons with extensive expertise in their respective fields. The recordings include didactic lectures and review of essential VESAP questions.

The recordings also provide a comprehensive update in all areas of vascular surgery. No CME credit is available.

Purchase the recordings here.

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Psoriasis cardiovascular risk parallels type 2 diabetes

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Psoriasis increased the measures of coronary artery calcium at a level similar to that seen in type 2 diabetes mellitus, independent of cardiovascular disease risk factors, based on data from a trio of cross-sectional studies including 387 adults. .

“Psoriasis and type 2 diabetes share similar cardiovascular risk profiles, which may predispose patients to developing coronary atherosclerosis at a relatively young age,” wrote Bobbak Mansouri, MD, of Baylor University Medical Center in Dallas and his associates (JAMA Dermatol. 2016. [doi: 10.1001/jamadermatol.2016.2907]).

©eenevski/thinkstockphotos

The researchers compared coronary artery calcium (CAC) levels in patients with psoriasis, patients with type 2 diabetes, and healthy controls. CAC has become an accepted measure of atherosclerosis and “the cornerstone for screening the risk of future cardiac events and improving cardiovascular risk stratification beyond traditional risk factors, especially in higher-risk groups,” according to the investigators. The average age of the patients was 52 years, 50% were female, and at least 92% were white.

The researchers used a hierarchical Tobit regression analysis to determine the association between disease and CAC level, as measured by the Agatston score. After controlling for confounding variables, including cardiovascular risk factors (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, systolic blood pressure, and tobacco use), the association with CAC was similar in psoriasis patients and type 2 diabetes patients (Tobit regression ratio [TRR], 0.89 and 0.79, respectively).

In a logistic multivariate regression analysis, patients with either psoriasis or type 2 diabetes were approximately twice as likely to have evidence of CAC as were healthy controls (odds ratio, 2.35 and 2.18, respectively), and psoriasis remained independently associated with the presence of CAC.

“When we added use of systemic or biological therapy to the models, the TRR and OR increased; however, these analyses were exploratory,” wrote Dr. Mansouri and his associates.

The study was limited by factors including the cross-sectional design and lack of diversity in the patient population, the investigators noted. However, the results suggest that “CAC assessment may be considered in patients with psoriasis who have two or more traditional cardiovascular risk factors given the high prevalence of CAC observed in this study,” they said.

Dr. Mansouri disclosed serving on an advisory board and receiving an honorarium from Celgene, maker of the psoriasis drug apremilast (Otezl). Study coauthors disclosed financial relationships with multiple pharmaceutical companies.

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Psoriasis increased the measures of coronary artery calcium at a level similar to that seen in type 2 diabetes mellitus, independent of cardiovascular disease risk factors, based on data from a trio of cross-sectional studies including 387 adults. .

“Psoriasis and type 2 diabetes share similar cardiovascular risk profiles, which may predispose patients to developing coronary atherosclerosis at a relatively young age,” wrote Bobbak Mansouri, MD, of Baylor University Medical Center in Dallas and his associates (JAMA Dermatol. 2016. [doi: 10.1001/jamadermatol.2016.2907]).

©eenevski/thinkstockphotos

The researchers compared coronary artery calcium (CAC) levels in patients with psoriasis, patients with type 2 diabetes, and healthy controls. CAC has become an accepted measure of atherosclerosis and “the cornerstone for screening the risk of future cardiac events and improving cardiovascular risk stratification beyond traditional risk factors, especially in higher-risk groups,” according to the investigators. The average age of the patients was 52 years, 50% were female, and at least 92% were white.

The researchers used a hierarchical Tobit regression analysis to determine the association between disease and CAC level, as measured by the Agatston score. After controlling for confounding variables, including cardiovascular risk factors (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, systolic blood pressure, and tobacco use), the association with CAC was similar in psoriasis patients and type 2 diabetes patients (Tobit regression ratio [TRR], 0.89 and 0.79, respectively).

In a logistic multivariate regression analysis, patients with either psoriasis or type 2 diabetes were approximately twice as likely to have evidence of CAC as were healthy controls (odds ratio, 2.35 and 2.18, respectively), and psoriasis remained independently associated with the presence of CAC.

“When we added use of systemic or biological therapy to the models, the TRR and OR increased; however, these analyses were exploratory,” wrote Dr. Mansouri and his associates.

The study was limited by factors including the cross-sectional design and lack of diversity in the patient population, the investigators noted. However, the results suggest that “CAC assessment may be considered in patients with psoriasis who have two or more traditional cardiovascular risk factors given the high prevalence of CAC observed in this study,” they said.

Dr. Mansouri disclosed serving on an advisory board and receiving an honorarium from Celgene, maker of the psoriasis drug apremilast (Otezl). Study coauthors disclosed financial relationships with multiple pharmaceutical companies.

Psoriasis increased the measures of coronary artery calcium at a level similar to that seen in type 2 diabetes mellitus, independent of cardiovascular disease risk factors, based on data from a trio of cross-sectional studies including 387 adults. .

“Psoriasis and type 2 diabetes share similar cardiovascular risk profiles, which may predispose patients to developing coronary atherosclerosis at a relatively young age,” wrote Bobbak Mansouri, MD, of Baylor University Medical Center in Dallas and his associates (JAMA Dermatol. 2016. [doi: 10.1001/jamadermatol.2016.2907]).

©eenevski/thinkstockphotos

The researchers compared coronary artery calcium (CAC) levels in patients with psoriasis, patients with type 2 diabetes, and healthy controls. CAC has become an accepted measure of atherosclerosis and “the cornerstone for screening the risk of future cardiac events and improving cardiovascular risk stratification beyond traditional risk factors, especially in higher-risk groups,” according to the investigators. The average age of the patients was 52 years, 50% were female, and at least 92% were white.

The researchers used a hierarchical Tobit regression analysis to determine the association between disease and CAC level, as measured by the Agatston score. After controlling for confounding variables, including cardiovascular risk factors (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, systolic blood pressure, and tobacco use), the association with CAC was similar in psoriasis patients and type 2 diabetes patients (Tobit regression ratio [TRR], 0.89 and 0.79, respectively).

In a logistic multivariate regression analysis, patients with either psoriasis or type 2 diabetes were approximately twice as likely to have evidence of CAC as were healthy controls (odds ratio, 2.35 and 2.18, respectively), and psoriasis remained independently associated with the presence of CAC.

“When we added use of systemic or biological therapy to the models, the TRR and OR increased; however, these analyses were exploratory,” wrote Dr. Mansouri and his associates.

The study was limited by factors including the cross-sectional design and lack of diversity in the patient population, the investigators noted. However, the results suggest that “CAC assessment may be considered in patients with psoriasis who have two or more traditional cardiovascular risk factors given the high prevalence of CAC observed in this study,” they said.

Dr. Mansouri disclosed serving on an advisory board and receiving an honorarium from Celgene, maker of the psoriasis drug apremilast (Otezl). Study coauthors disclosed financial relationships with multiple pharmaceutical companies.

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FROM JAMA DERMATOLOGY

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Key clinical point: Psoriasis patients have increased coronary artery calcium levels similar to those seen in type 2 diabetes patients, suggesting subclinical atherosclerosis.

Major finding: Psoriasis patients were more than twice as likely (odds ratio, 2.35) to have evidence of coronary artery calcium, compared with healthy controls.

Data source: A set of three single-center, cross-sectional studies totaling 387 adults and including individuals with psoriasis or type 2 diabetes, and healthy controls.

Disclosures: Dr. Mansouri disclosed serving on an advisory board and receiving an honorarium from Celgene, maker of the psoriasis drug apremilast (Otezl). Study coauthors disclosed financial relationships with multiple pharmaceutical companies.

Cycling accounts for the most sports-related ED visits

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Bicycle riding results in more visits to the emergency department than any other sports activity, according to the Agency for Healthcare Research and Quality.

In 2013, cycling accounted for 13.7% of the 2.8 million ED visits in which the patient was discharged. Walking/marching/hiking was next with 12.1% of ED visits, while unspecified sports activities were third with 10.3% of visits. Team sports took the next two spots: basketball accounted for 9.6% of visits and football accounted for 7.5%, the AHRQ reported.

Among those under age 18 years, who accounted for over 1.5 million ED visits (54.7%) in 2013, football was associated with the most visits for boys (16.4%) and school recess/summer camp led to the most visits (12.8%) for girls. Bicycle riding was the leading reason for males aged 18-44 (16%) and 45-64 (34.9%), while walking/marching/hiking was the leading reason for females aged 18-44 (25.6%) and 45-64 years (49%). For those older than 65 years, walking/marching/hiking was the most common reason for ED visits among both men (54.3%) and women (79.7%), according to data from the Nationwide Emergency Department Sample.

The most common injuries in 2013 for sports-related ED visits (discharged) were sprains (24%), fractures (21%), and superficial injuries (18%). Among the top 10 injury-producing sports activities, cycling had the highest rate of superficial injuries at 26%, school recess/summer camp had the highest fracture rate (42%), and basketball led with a sprain rate of 40%, the AHRQ said.

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Bicycle riding results in more visits to the emergency department than any other sports activity, according to the Agency for Healthcare Research and Quality.

In 2013, cycling accounted for 13.7% of the 2.8 million ED visits in which the patient was discharged. Walking/marching/hiking was next with 12.1% of ED visits, while unspecified sports activities were third with 10.3% of visits. Team sports took the next two spots: basketball accounted for 9.6% of visits and football accounted for 7.5%, the AHRQ reported.

Among those under age 18 years, who accounted for over 1.5 million ED visits (54.7%) in 2013, football was associated with the most visits for boys (16.4%) and school recess/summer camp led to the most visits (12.8%) for girls. Bicycle riding was the leading reason for males aged 18-44 (16%) and 45-64 (34.9%), while walking/marching/hiking was the leading reason for females aged 18-44 (25.6%) and 45-64 years (49%). For those older than 65 years, walking/marching/hiking was the most common reason for ED visits among both men (54.3%) and women (79.7%), according to data from the Nationwide Emergency Department Sample.

The most common injuries in 2013 for sports-related ED visits (discharged) were sprains (24%), fractures (21%), and superficial injuries (18%). Among the top 10 injury-producing sports activities, cycling had the highest rate of superficial injuries at 26%, school recess/summer camp had the highest fracture rate (42%), and basketball led with a sprain rate of 40%, the AHRQ said.

[email protected]

Bicycle riding results in more visits to the emergency department than any other sports activity, according to the Agency for Healthcare Research and Quality.

In 2013, cycling accounted for 13.7% of the 2.8 million ED visits in which the patient was discharged. Walking/marching/hiking was next with 12.1% of ED visits, while unspecified sports activities were third with 10.3% of visits. Team sports took the next two spots: basketball accounted for 9.6% of visits and football accounted for 7.5%, the AHRQ reported.

Among those under age 18 years, who accounted for over 1.5 million ED visits (54.7%) in 2013, football was associated with the most visits for boys (16.4%) and school recess/summer camp led to the most visits (12.8%) for girls. Bicycle riding was the leading reason for males aged 18-44 (16%) and 45-64 (34.9%), while walking/marching/hiking was the leading reason for females aged 18-44 (25.6%) and 45-64 years (49%). For those older than 65 years, walking/marching/hiking was the most common reason for ED visits among both men (54.3%) and women (79.7%), according to data from the Nationwide Emergency Department Sample.

The most common injuries in 2013 for sports-related ED visits (discharged) were sprains (24%), fractures (21%), and superficial injuries (18%). Among the top 10 injury-producing sports activities, cycling had the highest rate of superficial injuries at 26%, school recess/summer camp had the highest fracture rate (42%), and basketball led with a sprain rate of 40%, the AHRQ said.

[email protected]

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