Progress in cardiovascular diseases
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Prog Cardiovasc Dis · Jul 2015
ReviewProprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibition and the Future of Lipid Lowering Therapy.
Low-density lipoprotein cholesterol (LDL-C) reduction with statins is the cornerstone of atherosclerotic cardiovascular disease (CVD) prevention. The LDL-C lowering non-statin therapy ezetimibe also modestly reduces CVD risk when added to statin therapy. There remains a clinical need for additional LDL-C lowering agents to reduce CVD risk in patients with genetic hypercholesterolemia, statin intolerance, or who are at high risk due to clinical CVD or diabetes. ⋯ Regulatory approval for PCSK9 monoclonal antibodies may occur in the near future, and additional agents for PCSK9 inhibition are under development. This review focuses on the mechanism of LDL-C reduction using PCSK9 inhibition, as well as the phase I to III clinical trials of PCSK9 inhibitors. Results of the ongoing phase III CVD outcome trials are eagerly awaited.
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Prog Cardiovasc Dis · May 2015
ReviewCT Assessment of Myocardial Perfusion and Fractional Flow Reserve.
Coronary computed tomography angiography (CTA) offers a non-invasive method to detect coronary plaque and stenosis. However, to date, CTA has been most useful as a method of ruling out coronary artery disease (CAD) among patients with low to intermediate pretest probability of significant CAD. ⋯ Therefore, intense interest has focused on the development of methods to determine the functional significance of anatomical lesions identified by CTA. This article will discuss two emerging methods: stress myocardial perfusion imaging using CT, or CT perfusion, and computer simulation of fractional flow reserve.
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Prog Cardiovasc Dis · Mar 2015
ReviewClinical and research measurement techniques of the pulmonary circulation: the present and the future.
There has been a lot of progress in measurement techniques of the pulmonary circulation in recent years, and this has required updating of basic physiological knowledge. Pulmonary artery pressures (PAP) are normally low and dependent on left atrial pressure (LAP) and cardiac output (CO). Therefore, defining the functional state of the pulmonary circulation for the detection of pulmonary vascular disease or evaluation of disease progression requires measurements of PAP, LAP and CO. ⋯ Doppler echocardiography and magnetic resonance imaging are coming close. Both approaches are performant for flow measurements, but pressures remain indirectly assessed from flow velocities and/or structural changes. Doppler echocardiography or magnetic resonance imaging has been shown to be accurate, allowing for valid population studies, but with insufficient precision for single number-derived clinical decision making.
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Prog Cardiovasc Dis · Mar 2015
ReviewThe effect of exercise training on the pulmonary arterial system in patients with pulmonary hypertension.
Given the unique and clinically ominous pathology associated with pulmonary arterial (PA) hypertension (PH) and its implications for the eventual deterioration of right ventricular function, exercise training (ET) was historically not recommended. More recently, a body of literature demonstrating the safety and efficacy of ET in PH has emerged. ⋯ Nevertheless, studies have consistently found ET leads to numerous clinically relevant benefits including increased: 1) aerobic capacity, 2) muscle strength, 3) exercise tolerance, and 4) quality of life. Thus, ET, given its clinical benefits, is likely to enjoy increased utilization in patients with PH.
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Prog Cardiovasc Dis · Jan 2015
Inadequate physical activity and health care expenditures in the United States.
This study estimates the percentage of health care expenditures in the non-institutionalized United States (U. S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). ⋯ When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U. S. health care expenditures.