Sharon Smith

This study states that Cardiac hypertrophy is a key biological response to injurious stresses such as pressure overload and, when excessive, can lead to heart failure. Innate immune activation by danger signals, through intracellular pattern recognition receptors such as nucleotide-binding oligomerization domain 1 (Nod1) and its adaptor receptor-interacting protein 2 (RIP2), might play a major role in cardiac remodeling and progression to heart failure. We hypothesize that Nod1/RIP2 are major contributors to cardiac hypertrophy, but may not be sufficient to fully express the phenotype alone. To elucidate the contribution of Nod1/RIP2 signaling to cardiac hypertrophy, we randomized Nod1–/–, RIP2–/–, or wild-type mice to transverse aortic constriction or sham operations. Cardiac hypertrophy, fibrosis, and cardiac function were examined in these mice. Nod1 and RIP2 proteins were upregulated in the heart after transverse aortic constriction, and this was paralleled by increased expression

This study states that The VOYAGER PAD trial (Vascular Outcomes Study of ASA Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease) demonstrated superiority of rivaroxaban plus aspirin versus aspirin to reduce major cardiac and ischemic limb events after lower extremity revascularization. Clopidogrel is commonly used as a short-term adjunct to aspirin after endovascular revascularization. Whether clopidogrel modifies the efficacy and safety of rivaroxaban has not been described. VOYAGER PAD was a phase 3, international, double-blind, placebo-controlled trial in patients with symptomatic PAD undergoing lower extremity revascularization randomized to rivaroxaban 2.5 mg twice daily plus 100 mg aspirin daily or rivaroxaban placebo plus aspirin. The primary efficacy outcome was a composite of acute limb ischemia, major amputation of a vascular cause, myocardial infarction, ischemic stroke, or cardiovascular death. The principal safety end po

In this issue of Circulation, Cosentino and colleagues1 report the results of prespecified analyses from the VERTIS-CV trial (Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial) of the efficacy of the sodium glucose cotransporter 2 (SGLT2) inhibitor ertugliflozin on heart failure (HF)–related events in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease. The 8246 patients enrolled in VERTIS-CV were at least 40 years of age (mean age 64 years), and all had T2D with established atherosclerotic cardiovascular disease (coronary artery disease [76%], cerebrovascular disease [23%], and peripheral arterial disease [19%]). The mean duration of T2D was 12.9 years at baseline, with an average glycohemoglobin of 8.3%.2 The Table compares the main cardiovascular outcome trials for the SGLT2 inhibitors: the patients enrolled in VERTIS-CV are most similar to those in the EMPA-REG OUTCOME study (BI 10773 [Empagliflozin] Cardiovascula

This study states that Patients with type 2 diabetes mellitus (T2DM) are at high risk for heart failure (HF).1–4 The lifetime adjusted cumulative hazard for incident HF in patients with T2DM, hypertension, and obesity with an index age of 55 years reaches 60%.5 Moreover, patients with T2DM represent a substantial proportion of patients hospitalized for HF. In a large global registry, patients with history of atherothrombosis and T2DM had a 30% greater risk of hospitalization for HF (HHF) than patients with atherothrombosis but without T2DM.6 In a large European registry, T2DM was prevalent in approximately one-half of all patients admitted for HF in 1 year at 211 cardiology centers.7 In comparison with those patients without diabetes, patients with diabetes had higher cumulative rates of in-hospital and 1-year mortality, and 1-year HF rehospitalization, even when adjusting for multiple clinical risk factors.7 Results from clinical outcome trials with glucose-lowering therapies have yi

This study states that Critically ill patients are inherently susceptible to a multitude of complications related to both the severity of underlying illness and the need for intensive care therapies.1,2 Many of these complications are associated with increased morbidity and mortality and often result in greater resource use and healthcare expenses and longer intensive care unit (ICU) lengths of stay.1–3 A number of these complications are potentially preventable, and their incidence rates are used as quality metrics within modern-day ICU settings.4 Contemporary cardiac ICUs (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction.5,6 Thus, it stands to reason that patients admitted to contemporary CICUs will be susceptible to similar preventable complications associated with both their multisystem critical illness and the resources required to treat their complex conditions. At the same time, there is a need among CICU providers to unde

Kentucky firefighter Jimmy Adams saw the ravages of the coronavirus pandemic when he served as a medic who helped care for the sick on medical calls amid surging covid cases. He knew retired firefighters who died of complications from covid-19. But he reasoned that they were older and likely had underlying health issues, making them susceptible to the virus. “That’s how you make peace with those things,” said Adams, 51, a lieutenant. He believed the precautions his department was taking kept him safe. But he refused to get a covid vaccine. The reason wasn’t strictly political, he said. He had grown weary of the debate around masks, mitigation, caseloads and vaccines. In mid-August, both Adams and his wife, Sara, who was fully vaccinated, tested positive for covid. She experienced mild symptoms; however, he was hospitalized with bilateral interstitial pneumonia. His potassium spiked, causing cardiac arrhythmia. He was on oxygen throughout his hospitalization. “I was wrong,” Adams sa

The approval of a controversial new drug for Alzheimer’s disease, Aduhelm, is shining a spotlight on mild cognitive impairment — problems with memory, attention, language or other cognitive tasks that exceed changes expected with normal aging. After initially indicating that Aduhelm could be prescribed to anyone with dementia, the Food and Drug Administration now specifies that the prescription drug be given to individuals with mild cognitive impairment or early-stage Alzheimer’s, the groups in which the medication was studied. Yet this narrower recommendation raises questions. What does a diagnosis of mild cognitive impairment mean? Is Aduhelm appropriate for all people with mild cognitive impairment, or only some? And who should decide which patients qualify for treatment: dementia specialists or primary care physicians? Controversy surrounds Aduhelm because its effectiveness hasn’t been proved, its cost is high (an estimated $56,000 a year, not including expenses for imaging and

Colorado saw its worst fire season last year, with the three largest fires in state history and more than 600,000 acres burned . But some of the effects didn’t appear until this July, when heavy rain pushed sediment from damaged forests down mountainsides, causing mudslides that shut down sections of Interstate 70 for almost two weeks. Immense quantities of sediment choked the rivers that supply most of the state’s water. In western Colorado’s Glenwood Springs, the water became so murky that the town twice had to shut off the valves that pump water from nearby rivers to avoid overwhelming its filtration system. City managers sent alerts to the town’s 10,000 residents, telling them to minimize water use until the sediment moved downstream. Wildfires and their lasting effects are becoming a way of life in the West as climate change and management practices cause fires to increase in number, intensity and acreage burned, while extending the length of the fire season. In “burn scars,” w

Hours after the Supreme Court in 2012 narrowly upheld the Affordable Care Act but rejected making Medicaid expansion mandatory for states, Obama administration officials laughed when asked whether that would pose a problem. In a White House briefing, top advisers to President Barack Obama told reporters states would be foolish to turn away billions in federal funding to help residents lacking the security of health insurance. Flash-forward nearly a decade, and it’s clear to see the consequences of that ruling . Today, 12 Republican-controlled states have yet to adopt the Medicaid expansion, leaving 2.2 million low-income adult residents uninsured. Tired of waiting for Republican state lawmakers, congressional Democrats are moving to close the Medicaid coverage gap as they forge a package of new domestic spending that could run as high as $3.5 trillion over 10 years and would significantly enhance other federal health programs. But the cost is raising concerns within the party, and

“These guys [insurance companies and Washington bureaucrats] are working together to swipe $500 billion from Medicare to pay for Pelosi and Schumer’s out-of-control spending spree.” Video advertisement from the 60 Plus American Association of Senior Citizens The advertisement opens with a doctor sitting across from his patient and holding a prescription drug pill bottle. “You want to continue with this medication?” the doctor asks while an older patient nods. The doctor then explains that he can no longer provide the medicine to her because insurance companies and Washington bureaucrats “are working together to swipe $500 billion from Medicare to pay for [House Speaker Nancy] Pelosi and [Senate Majority Leader Chuck] Schumer’s out-of-control spending spree.” “They’re calling it Medicare negotiation, but, really, it’s just a way to cut your benefits and no longer pay for lifesaving medicines,” the doctor says. Medicare negotiation refers to the federal government bargaining direc

When Britney Spears last went before a judge, in June, she bristled as she told of being forced into psychiatric care that cost her $60,000 a month . Though the pop star’s circumstances in a financial conservatorship are unusual, every year hundreds of thousands of other psychiatric patients also receive involuntary care, and many are stuck with the bill . Few have Spears’ resources to pay for it, which can have devastating consequences. To the frustration of those who study the issue, data on how many people are involuntarily hospitalized and how much they pay is sparse. From what can be gathered, approximately 2 million psychiatric patients are hospitalized each year in the United States, nearly half involuntarily. One study found that a quarter of these hospitalizations are covered by private insurance, which often has high copays , and 10% were “self-pay/no charge,” where patients are often billed but cannot pay. I am a psychiatrist in New York City, and I have cared for hundre

Rural Americans are dying of covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated. While the initial surge of covid-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute . Since the pandemic began, about 1 in 434 rural Americans have died of covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are now more than double urban rates — and accelerating quickly. In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin

The fierce wildfires that broke out across much of the western United States this summer, spreading smoke across hundreds of miles, continue to pose a serious health hazard to millions. More are expected this fall. That’s a major health concern because microscopic particles in wildfire smoke, carried by the wind, can penetrate deep into your lungs and travel into your bloodstream. One study linked wildfire smoke exposure to a twofold increase in the rate of asthma and a 40% rise in strokes and heart attacks. Other research tied smoke to hospital admissions, ER visits and premature deaths. The standard advice is to stay inside when heavy smoke is in the air. But the smoke can get into your house or apartment. So you might want to consider investing in equipment to clean the air inside your home, especially with climate change likely to continue escalating the scope and intensity of the fires. “I think we have fires enough now that people should think of this as something they want

When covid-19 struck last year, Travis Warner’s company became busier than ever. He installs internet and video systems, and with people suddenly working from home, service calls surged. He and his employees took precautions like wearing masks and physically distancing, but visiting clients’ homes daily meant a high risk of covid exposure. “It was just like dodging bullets every week,” Warner said. In June 2020, an employee tested positive. That sent Warner and his wife on their own hunt for a test. Because of limited testing availability at the time, they drove 30 minutes from their home in Dallas to a free-standing emergency room in Lewisville, Texas. They received PCR diagnostic tests and rapid antigen tests. When all their results came back negative, it was a huge relief, Warner said. He eagerly got back to work. Then the bill came. The Patient: Travis Warner, 36, is self-employed and bought coverage from Molina Healthcare off the insurance marketplace. Medical Service: T