- Original ArticleAug 28, 202210.1056/NEJMoa2208335
In a randomized trial involving patients who had undergone percutaneous coronary intervention, routine functional testing did not improve clinical outcomes at 2 years.
- EditorialAug 28, 202210.1056/NEJMe2210021
More than 100 years ago, Einthoven reported the presence of ST-segment changes on electrocardiography in a patient during exercise.1 His discovery led to the development of the modern-day stress test. In patients with known coronary artery disease, the stress test is useful in assessing residual ischemia after an...
- Original ArticleAug 27, 202210.1056/NEJMoa2208681
Among older men in Denmark, the incidence of death from any cause at a median follow-up of 5.6 years was not significantly lower among those randomly invited to undergo screening for subclinical cardiovascular disease.
- EditorialAug 26, 202210.1056/NEJMe2210020
Next year marks the 20th anniversary of the first appearance of the polypill in the medical literature. Wald and Law coined the term to denote a fixed-dose combination of medications for preventing cardiovascular disease.1 They suggested that administering a polypill to all adults 55 years of age or...
- Original ArticleAug 26, 202210.1056/NEJMoa2208275
Among patients with recent MI, therapy with a polypill containing aspirin, ramipril, and atorvastatin led to a lower incidence of major adverse cardiovascular events at a median of 3 years than usual care.
- N Engl J Med 2022; 386:e58
A 27-year-old man presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. Pink-yellow papules were seen on examination. A blood sample was grossly lipemic.
- N Engl J Med 2022; 386:2129-2129
A 34-year-old woman presented with a 4-year history of progressive skin lesions and 3-month history of weight loss. Physical examination showed a symmetric distribution of clusters of pink-yellow papules that merged into branching projections on the trunk, buttocks, and all four limbs.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1877-1888
In this study, childhood cardiovascular risk factors including BMI, systolic blood pressure, lipid levels, and smoking were correlated with cardiovascular events in adulthood after a mean follow-up of 35 years. Childhood risk factors and the change in risk score between childhood and adulthood were associated with midlife cardiovascular events.
- N Engl J Med 2022; 386:1948-1949
Children almost never have myocardial infarctions or other adverse cardiovascular (CV) events, yet there has long been evidence that atherosclerosis may be found on postmortem examination of youths who have died accidently.1-3 Indeed, cohort studies such as the Cardiovascular Risk in Young Finns Study, the Bogalusa Heart Study,...
- N Engl J Med 2022; 386:230-240
In a randomized trial of secondary antibiotic prophylaxis in Ugandan children and adolescents with latent rheumatic heart disease, penicillin G benzathine given every 4 weeks for 2 years reduced the risk of disease progression. Among 458 participants in the prophylaxis group, 2 had serious adverse events that were attributable to...
- N Engl J Med 2021; 385:1881-1892
Environmental pollution is a cardiovascular risk factor. The Global Burden of Disease study estimated that pollution caused 9 million deaths in 2019, of which more than 60% were due to cardiovascular disease. Transitioning to renewable energy sources may reduce such deaths. This review summarizes the current evidence, and an interactive...
- N Engl J Med 2021; 385:1690-1698
Repair of abdominal aortic aneurysm is recommended in men with an aneurysm of 5.5 cm or more and in women with an aneurysm of 5.0 cm or more. In randomized trials, endovascular aortic aneurysm repair was associated with a lower risk of perioperative complications and death than open surgical repair,...
- N Engl J Med 2021; 385:1268-1279
In 8511 Chinese patients 60 to 80 years of age with hypertension, intensive treatment (systolic blood-pressure target, 110 to <130 mm Hg) resulted in a lower incidence of cardiovascular events than standard treatment (target, 130 to <150 mm Hg). The two groups had similar incidences of adverse events, except for...
- N Engl J Med 2021; 385:1328-1329
We often lament the lack of confirmatory studies that can either reassure us all that the previous evidence for a trialed intervention is robust or indicate that the evidence is questionable. Zhang and colleagues have conducted such a study — the STEP trial1 — which in essence investigates...
- N Engl J Med 2021; 384:2065-2066
The publication in the Journal of the results of ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness)1 comparing two doses of aspirin for the secondary prevention of cardiovascular disease represents a major step forward in establishing the pragmatic trial as an investigatory tool...
- N Engl J Med 2021; 384:1981-1990
In an open-label, pragmatic trial, patients with cardiovascular disease were randomly assigned to a strategy of 81 mg or 325 mg of aspirin daily. A substantial proportion of those assigned to the 325-mg dose switched to the 81-mg dose, and there were no significant differences in cardiovascular events or major...
- N Engl J Med 2021; 384:1248-1260
In patients with type 2 diabetes and established cardiovascular disease (or in those with a high risk of cardiovascular disease) in whom glycemic goals are not achieved with metformin, agents from the GLP-1 receptor agonist or SGLT2 inhibitor classes with demonstrated cardiovascular benefit constitute the recommended treatment.
A Half-Century of Progress in Health: The National Academy of Medicine at 50: Conquering Atherosclerotic Cardiovascular Disease — 50 Years of ProgressN Engl J Med 2021; 384:785-788
Substantial reductions in cardiovascular mortality in the United States reflect the power of a system that catalyzes the integration of basic science, translational research, technological innovation, evidence-based public policy, and public health practice.
- N Engl J Med 2021; 384:216-228
Participants without cardiovascular disease who were at increased risk were randomly assigned to receive a polypill (containing a statin and three blood-pressure–lowering drugs) or placebo and to receive aspirin or placebo. At 4.6 years, the incidence of cardiovascular events was lower among participants receiving both the polypill and aspirin than...