Sahar Naderi

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

Etiopathogenic differences in coronary artery disease and peripheral artery disease: results from the National Health and Nutrition Examination Survey.

Cross-sectional data from the National Health and Nutrition Examination Surveys 1999 to 2004 were pooled for this study. Compared with coronary artery disease (CAD), a greater proportion of individuals with peripheral artery disease (PAD) were female, black, and active smokers. Patients with PAD had significantly higher serum concentrations of low-density lipoprotein cholesterol and C-reactive protein than those with CAD alone. The risk of CAD increased with serum cotinine levels >0.02 ng/mL. However, the risk of PAD increased only with serum cotinine levels >138 ng/mL. Despite this association, there was no significant association of secondhand smoke exposure with CAD or PAD. In conclusion, patients with CAD and PAD differed with respect to several demographic and biochemical factors. The relationship between PAD and cotinine demonstrated a threshold phenomenon (serum cotinine levels >138 ng/mL).

High Prevalence of Metabolic Syndrome in Young Hispanic Women: Findings from the National Sister to Sister Campaign

BACKGROUND Hispanics are the fastest growing segment of the U.S. population and have a higher prevalence of cardiometabolic risk factors as compared with non-Hispanic whites. Further data suggests that Hispanics have undiagnosed complications of metabolic syndrome, namely diabetes mellitus, at an earlier age. We sought to better understand the epidemiology of metabolic syndrome in Hispanic women using data from a large, community-based health screening program. METHODS Using data from the Sister to Sister: The Womens Heart Health Foundation community health fairs from 2008 to 2009 held in 17 U.S. cities, we sought to characterize how cardiometabolic risk profiles vary across age for women by race and ethnicity. Metabolic syndrome was defined using the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, which included three or more of the following: Waist circumference ≥35 inches, triglycerides ≥150 mg/dL, high-density lipoprotein (HDL) <50 mg/dL, systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or a fasting glucose ≥100 mg/dL. RESULTS A total of 6843 community women were included in the analyses. Metabolic syndrome had a prevalence of 35%. The risk-adjusted odds ratio for metabolic syndrome in Hispanic women versus white women was 1.7 (95% confidence interval, 1.4, 2.0). Dyslipidemia was the strongest predictor of metabolic syndrome among Hispanic women. This disparity appeared most pronounced for younger women. Additional predictors of metabolic syndrome included black race, increasing age, and smoking. CONCLUSIONS In a large, nationally representative sample of women, we found that metabolic syndrome was highly prevalent among young Hispanic women. Efforts specifically targeted to identifying these high-risk women are necessary to prevent the cardiovascular morbidity and mortality associated with metabolic syndrome.

Statin intolerance: diagnosis, treatment and alternative therapies

Abstract Given evidence statins decrease cardiovascular morbidity and mortality, LDL reduction with statins is a mainstay in the treatment and prevention of cardiovascular disease. Despite their efficacy, statins can cause significant side effects in an estimated 5–10% of patients, commonly resulting in discontinuation of the drug. This review focuses on the pathophysiology, epidemiology and research surrounding statin-induced myopathy and hepatotoxicity. It will provide guidance in terms of diagnosis and proposed management of statin intolerance. Numerous side effects aside from myopathy and hepatotoxicity have been cited in the literature, and the most pertinent ones will be discussed here. Other potential alternatives to statin therapy will also be highlighted. Although much work needs to be done to demonstrate morbidity and mortality benefits of alternatives to statins, there are new therapies that hold promise within hyperlipidemia management.

Community Based Interventions in the Prevention of Cardiovascular Disease

Cardiovascular disease is the leading cause of death in both men and women in the United States with over 600,000 cardiovascular mortalities in 2008 alone. Given the burden of cardiovascular disease on both the individual and the healthcare system as a whole, substantial resources are invested in determining the most effective way of improving cardiovascular outcomes. As we have begun to better understand the impact of heart disease through epidemiologic data gathered on a national, regional, and city level, community-based interventions (CBI) have been targeted as a potential means of tackling this epidemic. This review focuses on the types of CBIs in terms of the targeted risk factors and setting of the intervention, challenges in their development, and future directions for research focus.