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New England Journal of Medicine

Recognizing Blind Spots — A Remedy for Gender Bias in Medicine?
New England Journal of Medicine, Volume 378, Issue 24, Page 2253-2255, June 2018.
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Lost Taussigs — The Consequences of Gender Discrimination in Medicine
New England Journal of Medicine, Volume 378, Issue 24, Page 2255-2257, June 2018.
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The 2017 Nobel Peace Prize and the Doomsday Clock — The End of Nuclear Weapons or the End of Us?
New England Journal of Medicine, Volume 378, Issue 24, Page 2258-2261, June 2018.
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Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery
New England Journal of Medicine, Volume 378, Issue 24, Page 2263-2274, June 2018.
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Heartbeat: cardiovascular disease risk and reproductive factors in women
The likelihood of cardiovascular disease (CVD) in both women and men largely is explained by well-known lifestyle and clinical risk factors. Several studies have suggested that a woman’s reproductive history also might affect the risk of CVD, but results have been inconsistent and methodology suboptimal. In this issue of Heart, Peters and Woodward1 report the association between several reproductive factors and subsequent incident CVD over 7 years of follow-up in 482,000 participants in the UK Biobank study with CVD defined as incident myocardial infarction (fatal or non-fatal) or stroke.1 The risk of CVD was increased in women with early menarche (<12 years), early menopause (<47 years), younger age at first birth, or a history of miscarriage, stillbirth or hysterectomy (figure 1). Interestingly, in both men and women, each additional child was associated with an increased risk of CVD with an HR of 1.03...
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Resting heart rate: what is normal?
Resting heart rate (RHR) is a clinical parameter easily measurable with typical value between 50 and 90 beats per minute (bpm) that varies during the day with a night-time decrease.1 RHR can go down to 30 bpm in those with good physical condition, but RHR is also partly genetically determined, with slightly higher values in women than in men.2 The interpretation of RHR by clinicians is traditionally done in the acute setting, typically for evaluation of pulmonary embolism or acute infection. It is now possible to continuously and accurately self-measure RHR using a mobile phone or a watch bracelet, so that monitoring RHR has become very popular in the general population.3 Therefore, it is important for physicians to know the clinical significance of RHR and its usefulness for chronic disease prevention in healthy adults. Life expectancy of animal species is inversely correlated with their RHR.
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JACC Instructions for Authors
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Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus
AbstractBackground Evidence is limited regarding the impact of healthy lifestyle practices on the risk of subsequent cardiovascular events among patients with diabetes. Objectives The purpose of this study was to examine the associations of an overall healthy lifestyle, defined by eating a high-quality diet (top two-fifths of Alternative Healthy Eating Index), nonsmoking, engaging in moderate- to vigorous-intensity physical activity (≥150 min/week), and drinking alcohol in moderation (5 to 15 g/day for women and 5 to 30 g/day for men), with the risk of developing cardiovascular disease (CVD) and CVD mortality among adults with type 2 diabetes (T2D). Methods This prospective analysis included 11,527 participants with T2D diagnosed during follow-up (8,970 women from the Nurses’ Health Study and 2,557 men from the Health Professionals Follow-Up Study), who were free of CVD and cancer at the time of diabetes diagnosis. Diet and lifestyle factors before and after T2D diagnosis were repeatedly assessed every 2 to 4 years. Results There were 2,311 incident CVD cases and 858 CVD deaths during an average of 13.3 years of follow-up. After multivariate adjustment of covariates, the low-risk lifestyle factors after diabetes diagnosis were each associated with a lower risk of CVD incidence and CVD mortality. The multivariate-adjusted hazard ratios for participants with 3 or more low-risk lifestyle factors compared with 0 were 0.48 (95% confidence interval [CI]: 0.40 to 0.59) for total CVD incidence, 0.53 (95% CI: 0.42 to 0.66) for incidence of coronary heart disease, 0.33 (95% CI: 0.21 to 0.51) for stroke incidence, and 0.32 (95% CI: 0.22 to 0.47) for CVD mortality (all p trend <0.001). The population-attributable risk for poor adherence to the overall healthy lifestyle (<3 low-risk factors) was 40.9% (95% CI: 28.5% to 52.0%) for CVD mortality. In addition, greater improvements in healthy lifestyle factors from pre-diabetes to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and CVD mortality. For each number increment in low-risk lifestyle factors there was a 14% lower risk of incident total CVD, a 12% lower risk of coronary heart disease, a 21% lower risk of stroke, and a 27% lower risk of CVD mortality (all p < 0.001). Similar results were observed when analyses were stratified by diabetes duration, sex/cohort, body mass index at diabetes diagnosis, smoking status, and lifestyle factors before diabetes diagnosis. Conclusions Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and CVD mortality among adults with T2D. These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in patients with T2D.
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Lifestyle and CV Risk in Patients With Diabetes: Time to Get "Back to Basics"
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Bioimpedance-Guided Hydration for the Prevention of Contrast-Induced Kidney Injury: The HYDRA Study
AbstractBackground Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status. Objectives The goal of this study was to compare the effect of standard and double intravenous (IV) infusion volumes in patients with low body fluid level, assessed by using bioimpedance vector analysis (BIVA), on the incidence of CI-AKI after elective coronary angiographic procedures. Methods A total of 303 patients with low BIVA level on admission were randomized to receive standard volume saline (1 ml/kg/h for 12 h before and after the procedure) or double volume saline (2 ml/kg/h). Patients (n = 715) with an optimal BIVA level received standard volume saline and were included in a prospective registry. The saline infusion was halved in all patients with an ejection fraction <40%. BIVA was repeated immediately before the angiographic procedure in all patients. CI-AKI was defined as an increase in levels of cystatin C ≥10% above baseline at 24 h after contrast administration. Results The incidence of CI-AKI was significantly lower (11.5% vs. 22.3%; p = 0.015) in patients receiving double volume saline than in those receiving standard volume saline, respectively. Before the angiographic procedure, 50% of the double volume patients achieved the optimal BIVA level compared with only 27.7% in the standard group (p = 0.0001). The findings were consistent in all the pre-specified subgroups excluding patients with a left ventricular ejection fraction <40% (p for interaction = 0.01). Conclusions Evaluation of BIVA levels on admission in patients with stable coronary artery disease allows adjustment of intravascular volume expansion, resulting in lower CI-AKI occurrence after angiographic procedures. (Personalized Versus Standard Hydration for Prevention of CI-AKI: A Randomized Trial With Bioimpedance Analysis; NCT02225431)
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Heart Rhythm