Circulation. 2007;115:2087
doi: 10.1161/CIRCULATIONAHA.107.182501
(Circulation. 2007;115:2087.)
© 2007 American Heart Association, Inc.
Issue Highlights
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DEFINING OBESITY CUT POINTS IN A MULTIETHNIC POPULATION, by Razak et al.
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Current clinical thresholds for defining obesity were derived
from samples that were predominantly white and of European descent.
The generalizability of these thresholds to other ethnicities
and races has been disputed. Razak and colleagues used principal
components factor analysis to derive thresholds for obesity
based on 3 cardiovascular disease factors: glucose metabolism,
lipid metabolism, and blood pressure. They applied these factors
to >1000 individuals from 4 ethnic groups in Canada, including
South Asians, Chinese, Aboriginals, and Europeans, and observed
that the threshold to define obesity is
6 kg/m
2 lower among
non-European than European individuals. Definitive obesity thresholds
will require further examination in larger samples from other
countries and other ethnicities/races and will require cardiovascular
disease end points. However, the investigation by Razak et al
has 2 major implications: 1) The threshold for obesity of 30
gm/m
2 is inappropriately high in many nonwhite individuals,
and 2) the global burden of obesity is much larger than currently
appreciated. See p 2111 (editorial p
2089).
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ADHERENCE TO STATIN THERAPY UNDER DRUG COST SHARING IN PATIENTS WITH AND WITHOUT ACUTE MYOCARDIAL INFARCTION: A POPULATION-BASED NATURAL EXPERIMENT, by Schneeweiss et al.
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Financial barriers to medication use are associated with worse
outcomes for patients with acute myocardial infarction. These
barriers can affect medication use even for patients with health
insurance, raising questions about how coverage for medications
affects patient behavior. Investigators were able to take advantage
of a natural experiment in British Columbia, where an evolution
of coverage occurred over a 4-year period. In 2001, full drug
coverage existed, whereas in 2002, a $10 or $25 copay was instituted,
and in 2003–2004, 25% coinsurance was implemented. The
study examines the effect of these coverage policies on adherence
to new statin therapy for patients after acute myocardial infarction
and initiation of statin therapy. This study by Schneeweiss
et al has important implications for national discussions about
the consequences of imposing a patient payment component on
medication coverage. See p
2128.
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PREDICTORS OF OUTCOME IN CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION, by Bonderman et al.
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Chronic thromboembolic pulmonary hypertension is an infrequently
encountered clinical syndrome. However, unlike many other causes
of pulmonary hypertension, it is potentially amenable to a direct
therapy, surgical pulmonary endarteretomy. Most series of chronic
thromboembolic pulmonary hypertension patients are relatively
small, and thus, characteristics of patients who may or may
not have higher-risk prognosis or be better surgical candidates
are not well defined. In this issue of
Circulation, Bonderman
and colleagues report on a large single-center series including
all chronic thromboembolic pulmonary hypertension patients referred
for consideration of pulmonary endarteretomy in Austria over
a 15-year span. Over a median of
2 years follow-up in this observational
series, the presence of comorbidities such as splenectomy, ventriculoatrial
shunt, permanent central intravenous lines, inflammatory bowel
disease, and osteomyelitis was associated with unfavorable outcomes.
Pulmonary endarteretomy was associated with reduction in risk
of death, but the presence of those comorbidities increased
the chance of postoperative mortality or persistent pulmonary
hypertension. These data should allow more informed decision
making for this challenging syndrome. See p
2153.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Magnetic Resonance Imaging Guiding Pacemaker Implantation for
Severe Sinus Node Dysfunction Due to Cardiac Involvement in
Erdheim-Chester Disease. See p
e412.
Metastatic Extracavitary Cardiac Melanoma: The Role of Contemporary Imaging Techniques in Diagnosis and Surgical Planning. See p e415.
Percutaneous Epicardial Mapping and Ablation of a Posteroseptal Accessory Pathway. See p e418.
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Book Review
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The Vulnerable Atherosclerotic Plaque: Strategies for Diagnosis
and Management. See p
e422.
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Correspondence
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See p
e424.
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New International Measuring Stick for Defining Obesity in Non-Europeans
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Circulation 2007 115: 2089-2090.
[Extract]
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The Vulnerable Atherosclerotic Plaque: Strategies for Diagnosis and Management
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Letter by Vogt Regarding Article, "Reduction in the Incidence of Acute Myocardial Infarction Associated With a Citywide Smoking Ordinance"
- Richard L. Vogt
Circulation 2007 115: e424.
[Extract]
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Predictors of Outcome in Chronic Thromboembolic Pulmonary Hypertension
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Circulation 2007 115: 2153-2158.
[Abstract]
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Adherence to Statin Therapy Under Drug Cost Sharing in Patients With and Without Acute Myocardial Infarction: A Population-Based Natural Experiment
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DEFINING OBESITY CUT POINTS...
ADHERENCE TO STATIN THERAPY...