Among inpatients with AMI, the lowest mortality was observed in those with postadmission serum potassium levels between 3.5 and <4.5 mEq/L compared with those who had higher or lower potassium levels.

LEVATED GLUCOSE LEVELS IN the setting of acute myocardial infarction (AMI) is a wellrecognized risk factor for increased mortality, 1-27 and limited clinical trial data suggest that better glucose control may improve patient outcomes after AMI. 28 Based on these findings, professional societies currently endorse glucose control in patients with hyperglycemia hospitalized with AMI. 29-31 Enthusiasm for glucose-lowering interventions has been tempered, in part, by concerns of inducing hypoglycemia because randomized controlled trials of intensive glucose control with insulin have shown higher rates of hypoglycemia than standard glucose management. 32-35 The concerns generated by these findings were further heightened after several observational studies showed that hypoglycemia during a hospitalization for AMI was associated with higher mortality. 22,26,36 However, these studies could not distinguish between hypoglycemia that occurs spontaneously (due to severe illness) and hypoglycemic events that occur as a consequence of glucoselowering therapy.

Background and Purpose The American Heart Association developed Life’s Simple 7 (LS7) as a metric defining cardiovascular health. We investigated the association between LS7 and incident stroke in black and white Americans. Methods REGARDS is a national population-based cohort of 30,239 blacks and whites, aged ≥45 years, sampled from the US population in 2003 – 2007. Data were collected by telephone, self-administered questionnaires and an in-home exam. Incident strokes were identified through bi-annual participant contact followed by adjudication of medical records. Levels of the LS7 components (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet) were each coded as poor (0 point), intermediate (1 point) or ideal (2 points) health. An overall LS7 score was categorized as inadequate (0–4), average (5–9) or optimum (10–14) cardiovascular health. Results Among 22,914 subjects with LS7 data and no previous cardiovascular disease, there were 432 incident strokes over 4.9 years of follow-up. After adjusting for demographics, socioeconomic status, and region of residence, each better health category of the LS7 score was associated with a 25% lower risk of stroke (HR=0.75, 95% CI = 0.63, 0.90). The association was similar for blacks and whites (interaction p-value = 0.55). A one point higher LS7 score was associated with an 8% lower risk of stroke (HR=0.92, 95% CI=0.88, 0.95). Conclusion In both blacks and whites better cardiovascular health, based on the LS7 score, is associated with lower risk of stroke, and a small difference in scores was an important stroke determinant.

Both higher baseline glucose and the failure of glucose levels to decrease in the first 24 h after AMI predict higher mortality in nondiabetic patients.

The lack of standardized reporting of the magnitude of ischemia on noninvasive imaging contributes to variability in translating the severity of ischemia across stress imaging modalities. We identified the risk of coronary artery disease (CAD) death or myocardial infarction (MI) associated with ≥10% ischemic myocardium on stress nuclear imaging as the risk threshold for stress echocardiography and cardiac magnetic resonance. A narrative review revealed that ≥10% ischemic myocardium on stress nuclear imaging was associated with a median rate of CAD death or MI of 4.9%/year (interquartile range: 3.75% to 5.3%). For stress echocardiography, ≥3 newly dysfunctional segments portend a median rate of CAD death or MI of 4.5%/year (interquartile range: 3.8% to 5.9%). Although imprecisely delineated, moderate-severe ischemia on cardiac magnetic resonance may be indicated by ≥4 of 32 stress perfusion defects or ≥3 dobutamine-induced dysfunctional segments. Risk-based thresholds can define equivalent amounts of ischemia across the stress imaging modalities, which will help to translate a common understanding of patient risk on which to guide subsequent management decisions.

Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).

Importance Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged >65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (≥median) and high CFR (≥median) were identified. Setting Population-based study of U.S. county-level data. Participants U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures COVID-19 CFR and incidence. Results Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1 unit increase), an association that strengthened after adjustment for age>65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (≥0.46) and high adjusted CFR (≥2.3%) was observed in 28.9% of counties. Conclusions and Relevance Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population.

MALL EXPERIMENTAL AND CLINIcal studies have supported the u s e o f g l u c o s e -i n s u l i npotassium (GIK) infusion in the treatment of acute ST-segment elevation myocardial infarction (STEMI). [1][2][3][4] However, the Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction T r e a t m e n t a n d E v a l u a t i o n -Estudios Clinicos Latino America (CREATE-ECLA) 5 of 20 201 patients with acute STEMI demonstrated a neutral effect of GIK infusion on 30day mortality. A separate study, the Organization for the Assessment of Strategies for Ischemic Syndromes-6 (OASIS-6) trial, evaluated the effect of GIK infusion vs no infusion on 6-month clinical outcomes in 2748 patients with acute STEMI. The principal results of the GIK component of the OASIS-6 trial through 6 months are presented herein.