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New England Journal of Medicine

Biological Citizenship — A 53-Year-Old Man with Schizoaffective Disorder and PTSD Applying for Supplemental Security Income
New England Journal of Medicine, Volume 381, Issue 21, Page 1985-1989, November 2019.
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Eastern Equine Encephalitis Virus — Another Emergent Arbovirus in the United States
New England Journal of Medicine, Volume 381, Issue 21, Page 1989-1992, November 2019.
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The Den
New England Journal of Medicine, Volume 381, Issue 21, Page 1992-1993, November 2019.
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Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction
New England Journal of Medicine, Volume 381, Issue 21, Page 1995-2008, November 2019.
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Heartbeat: the potential power of naps for cardiovascular health
The significance of napping for cardiovascular disease (CVD) has been a matter of controversy, with studies showing discordant results depending on the methods of evaluation, nap duration, age range of the population and outcomes measured (total vs cardiovascular mortality or events). In this issue of Heart, Häusler and colleagues1 studied the association between napping, characterised by weekly nap frequency and daily nap duration, and fatal and non-fatal CVD events in a Swiss population-based cohort (CoLaus). Subjects (n=3462) with no previous history of CVD reported their weekly nap frequency and daily nap duration, and were followed over 5.3 years for fatal and non-fatal CVD events. The authors initially observed a J-shape curved relationship between nap frequency and CVD events, with subjects napping one to two times weekly having half of the risk compared with non-napping subjects in unadjusted and adjusted models (HR 0.52, 95% CI 0.28 to 0.95). Although...
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To nap or not to nap: more questions than answers
We spend a third of our lives in sleep. One of the most common yet understudied sleep behaviours in human beings is daytime napping. While napping is traditionally viewed as a countermeasure to sleepiness and as a strategy to boost performance, especially in healthy younger adults or among shift workers,1 the effects of napping in middle-aged to older-aged populations are largely unknown. One key question is whether naps are protective or harmful for heart health among older adults. A pioneering Greek case–control study from the late 1980s2 compared 97 men with an acute episode of coronary heart disease (CHD) and 90 control subjects, and showed a 30% reduction in the incidence of CHD associated with a 30 min afternoon nap. Over the past decade, growing epidemiological evidence has pointed to napping as a risk factor for cardiovascular disease (CVD), and a recent meta-analysis3 summarised...
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JACC Instructions for Authors
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Effects of Interatrial Shunt on Pulmonary Vascular Function in Heart Failure With Preserved Ejection Fraction
AbstractBackground Implantation of an interatrial shunt device (IASD) in patients with heart failure (HF) reduces left atrial hypertension by shunting oxygenated blood to the right heart and lungs. The attendant increases in pulmonary blood flow (Qp) and oxygen content may alter pulmonary vascular function, while left-to-right shunting might compromise systemic perfusion. Objectives The authors hypothesized that IASD would improve indexes of pulmonary artery (PA) function at rest and during exercise in HF patients without reducing systemic blood flow (Qs). Methods This is a pooled analysis from 2 trials assessing the effects of the IASD on resting and exercise hemodynamics in HF patients (n = 79) with EF ≥40% with baseline and repeated hemodynamic evaluation between 1 and 6 months. Patients with pulmonary vascular resistance (PVR) >4 WU or right ventricular dysfunction were excluded. Results Qp and PA oxygen content increased by 27% and 7% following IASD. These changes were associated with salutary effects on pulmonary vascular function (17% reduction in PVR, 12% reduction in PA elastance [pulmonary Ea], and 24% increase in PA compliance). Qp increased during exercise to a greater extent following IASD compared with baseline, which was associated with reductions in exercise PVR and pulmonary Ea. Patients with increases in PA compliance following IASD experienced greater improvements in supine exercise duration. There was no reduction in Qs following IASD at rest or during exercise. Conclusions Implantation of an IASD improves pulmonary vascular function at rest and during exercise in selected patients with HF and EF ≥40%, without compromising systemic perfusion. Further study is warranted to identify underlying mechanisms and long-term pulmonary hemodynamic effects of IASD. (REDUCE LAP-HF Trial [REDUCE LAP-HF]; NCT01913613; and REDUCE LAP-HF Randomized Trial I [REDUCE LAP-HF I]; NCT02600234)
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Hemodynamic Effects of Iatrogenic Interatrial Shunts: Communication Is Key
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Effects of Statins on Memory, Cognition, and Brain Volume in the Elderly
AbstractBackground There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline. Objectives This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined. Methods Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein E4 carriage. Interactions were sought between statin use and dementia risk factors. Results Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein E4 carriage. There was no difference in brain volume changes between statin users and never users. Conclusions In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.
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Heart Rhythm