Background: Persons with atherosclerotic cardiovascular disease (ASCVD) on statins remain at higher risk of CV events. The added residual risk that diabetes mellitus (DM) confers has not been well-quantified. We examined initial and total ASCVD events in statin treated persons with ASCVD and the added risk of DM.
Methods: We studied 3,271 subjects with ASCVD on statins from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes trial cohort. We examined rates for first and total ASCVD events. Cox regression examined the risk of first ASCVD events over 3 years with and without DM at baseline.
Results: 40% of subjects had DM. Those with vs. without DM were slightly older, less likely male, white, currently smoking, had higher systolic but lower diastolic blood pressure, lower HDL-C, LDL-C, lipoprotein (a), but higher triglycerides and BMI (all p<0.01). First and total ASCVD event rates are shown (Figure). Total ASCVD events were about 50% greater than initial events, with the difference largest in men with DM. From fully adjusted analyses, DM conferred a 22% greater risk of first ASCVD events compared to no DM (HR=1.22, 95% CI=1.03-1.44, p=0.02).
Conclusion: Despite statin therapy, DM carries significantly greater residual risk over having ASCVD alone. More aggressive approaches are needed to reduce the increased risk with ASCVD and DM.
Disclosure
N.D. Wong: Advisory Panel; Self; Novartis Pharmaceuticals Corporation. Consultant; Self; Akcea Therapeutics, AstraZeneca. Research Support; Self; Amarin Corporation, Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Y. Zhao: None. P. Xiang: Employee; Self; Amgen Inc. J.G. Lopez: Employee; Self; Amgen Inc. Stock/Shareholder; Self; Amgen Inc.
Funding
Amgen Inc.
In this paper I would like to lay out some considerations concerning the concept of dispersion, aimed at the understanding of a decisive dynamic of contemporary life. As a lead, I will use Benjamin's approach relating to dispersion, extrapolating certain points that allow me to shed some light on present-day education. The idea of dispersion has a story that I would sketch in broad outline in order to distinguish the value-based attitudes raised by the phenomenon, and the difficulty of assigning a positive sense. I will refer to two representatives that I believe maintain profound relative significance and define the philosophical situation of dispersion in the Western tradition: Saint Augustine and Heidegger. From this outline it is possible to grasp the central problem of the ambiguity that accompanies the attitude towards dispersion and its historical correlate, the loss of aura, which can be expressed in the opposition between a liquidationist liberalism or an elegiac conservatism.
Key words:Dispersion, aura, education, attention, contemplation, Benjamin, Heidegger, existence.
Abstract
Resumen
206Walter Benjamin: dispersión y educación en la época contemporánea Germán Darío Velez López
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