Coronary Artery Calcium Scan Embraced By New AHA/ACC Cholesterol Guidelines: Will Insurance Coverage Follow?

Thank you Dr. Pearson.

The Skeptical Cardiologist

The skeptical cardiologist has been utilizing coronary artery calcium (CAC) scans to help decide which patients are at high risk for heart attacks, and sudden cardiac death for the last decade. As I first described in 2014, (see here) those with higher than expected calcium scores warrant more aggressive treatment and those with lower scores less aggrressive treatment.

Although , as I have discussed previously, CAC is not the “mammography of the heart” it is incredibly helpful in sorting out personalized cardiovascular risk. We use standard risk factors like lipids, smoking, age, gender and diabetes to stratify individuals according to their 10 year risk of atherosclerotic cardiovascular disease (ASCVD) but many apparent low risk individuals (often due to inherited familial risk) drop dead from ASCVD and many apparent high risk individuals don’t need statin therapy.

Previously, major guidelines from organizations like the AHA and the ACC did not recommend…

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Eat More Cashews

Conclusion

Cashew nut supplementation in Asian Indians with T2DM reduced systolic blood pressure and increased HDL cholesterol concentrations with no deleterious effects on body weight, glycemia, or other lipid variables. This study was registered at the clinical trial registry of India as CTRI/2017/07/009022.

Cashew Nut Consumption Increases HDL Cholesterol and Reduces Systolic Blood Pressure in Asian Indians with Type 2 Diabetes: A 12-Week Randomized Controlled Trial

This explains why cashews are my favorite nut.

I’m the guy who picks out all of the cashews in a bowl of mixed nuts.

Eating regular variety of nuts associated with lower risk of heart disease

People who regularly eat nuts, including peanuts, walnuts and tree nuts, have a lower risk of developing cardiovascular disease or coronary heart disease compared to people who never or almost never eat nuts, according to a new study. The study is the largest to date looking at frequency of nut consumption in relation to incident cardiovascular disease.

The study found a consistent inverse association between total nut consumption and total cardiovascular disease and coronary heart disease. Also, after looking at individual nut consumption, eating walnuts one or more times per week was associated with a 19 percent lower risk of cardiovascular disease and 21 percent lower risk of coronary heart disease. Participants who ate peanuts or tree nuts two or more times per week had a 13 percent and 15 percent lower risk of cardiovascular disease, respectively, and a 15 percent and 23 percent, lower risk of coronary heart disease, respectively, compared to those who never consumed nuts.

Participants who consumed five or more servings of nuts a week had a 14 percent lower risk of cardiovascular disease and a 20 percent lower risk of coronary heart disease than participants who never or almost never consumed nuts. The results were similar when accounting for consumption of tree nuts, peanuts and walnuts individually. Researchers found no evidence of an association between total nut consumption and risk of stroke, but eating peanuts and walnuts was inversely associated with the risk of stroke. Peanut butter and tree nuts were not associated with stroke risk.

So that bowl of nuts on the bar?  Yes, eat them.

Source article here.

Atrial Fibrillation – Circulation Research

Source: Atrial Fibrillation | Circulation Research

Abstract

The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.