underwriting

Calcium Scoring May Miss CAD

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Medical News: Calcium Scoring Misses 20% of CAD Cases – in Cardiovascular, Acute Coronary Syndrome from MedPage Today

Contrary to guidelines, the absence of coronary artery calcium doesn’t rule out coronary artery disease in symptomatic patients, researchers found in a new study.

In a multicenter clinical trial, 19% of patients with a coronary calcium score of 0 had stenosis of at least 50% in one or more coronary artery segments, according to Carlos E. Rochitte, MD, of the University of São Paulo, Brazil, and colleagues.

Likewise, 20% of vessels seen to be totally occluded on revascularization had no calcium on scans, they reported in the Feb. 16 issue of the Journal of the American College of Cardiology.

“The absence of coronary calcification should not be used as a gatekeeper and should not prevent a symptomatic patient from undergoing angiography,” the researchers wrote.

Oops.

The Contingent Workforce – a $425 Billion Market

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You’re Hired. At Least for Now. – Kiplinger.com

The job is not a timeless fact of human existence.  It is a social artifact.

William Bridges wrote these words over 15 years ago.  We need to fully understand this concept and decide what kind of future we want for ourselves.  Do you want to be in or out?  Nearly four years ago I started my business on a part-time basis.  One year ago, I became  100% self-employed. If you are an underwriter, the time to be an independent for hire has never been better.

If you’re in underwriting management your options for creating the right hybrid model to fit your needs has never been better.  I’ve said it before and I’ll say it again:

I have a mortgage, two kids in college, and a small fleet of cars to support.  Hire me please.

ASA May Reduce CVD and All-Cause Mortality in T2DM

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Aspirin Is Associated With Reduced Cardiovascular and All-Cause Mortality in Type 2 Diabetes in a Primary Prevention Setting — Diabetes Care

RESULTS There were 160 deaths (24.6%) during follow-up, with 70 (43.8%) due to CVD. In Kaplan-Meier survival analysis, there was no difference in either CVD or all-cause mortality in aspirin users versus nonusers (P = 0.52 and 0.94, respectively, by log-rank test). After adjustment for significant variables in the most parsimonious Cox models, regular aspirin use at baseline independently predicted reduced CVD and all-cause mortality (hazard ratio [HR] 0.30 [95% CI 0.09–0.95] and 0.53 [0.28–0.98[, respectively; P ≤ 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged ≥65 years and men.

CONCLUSIONS Regular low-dose aspirin may reduce all-cause and CVD mortality in a primary prevention setting in type 2 diabetes. All-cause mortality reductions are greatest in men and in those aged ≥65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients.

Increased CIMT in T2DM = Abnormal Myocardial Perfusion

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Increased Carotid Intima-Media Thickness as a Predictor of the Presence and Extent of Abnormal Myocardial Perfusion in Type 2 Diabetes — Diabetes Care

CONCLUSIONS Increased CIMT was significantly related to the presence and extent of abnormal myocardial perfusion. Assessment of CIMT may be useful to identify asymptomatic patients with type 2 diabetes at higher risk for CAD.

RESULTS Increased CIMT was an independent predictor of the extent of abnormal perfusion (P < 0.001). In patients with increased CIMT as compared with patients with normal CIMT, abnormal perfusion (75 vs. 9%) and severely abnormal perfusion (28 vs. 3%) were observed more frequently.

Proteinuria Matters

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Medical News: Protein in Urine Presages More Severe Problems – in Nephrology, ESRD from MedPage Today

The three-year risk of death, heart attack, and kidney failure was markedly increased in patients with baseline proteinuria, regardless of their estimated glomerular filtration rate (eGFR), researchers said.

In a population-based study of nearly 1 million people, mortality was approximately doubled with heavy proteinuria among individuals stratified according to their eGFR, reported Brenda R. Hemmelgarn, MD, PhD, of the University of Calgary in Canada, and colleagues.

Rates of myocardial infarction were increased by about 50% with heavy proteinuria, and end-stage renal disease and doubled levels of serum creatinine were as much as 30 times more common, the researchers reported in the Feb. 3 issue of the Journal of the American Medical Association.

Tysabri (Natalizumab) and PML – Update

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Medical News: FDA Adds PML Risk to MS Drug Label – in Product Alert, Prescriptions from MedPage Today

A warning of a risk of progressive multifocal leukoencephalopathy has been added to the label for the multiple sclerosis drug natalizumab (Tysabri), the FDA announced. The labeling change was prompted by continuing reports of PML in MS patients. The current number of confirmed cases stands at 31 — 10 in the U.S. — up from 13 as recently as last September.