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Deceleration in the decline of all CVD, HD, and stroke mortality rates has occurred since 2011. If this trend continues, strategic goals for lowering the burden of CVD set by the American Heart Association and the Million Hearts Initiative may not be reached.

Background-The comparative importance of physical inactivity and obesity as predictors of coronary heart disease (CHD) risk remains unsettled. Methods and Results-We followed 88 393 women, 34 to 59 years of age, in the Nurses' Health Study from 1980 to 2000.These participants did not have cardiovascular disease and cancer at baseline. We documented 2358 incident major CHD events (including nonfatal myocardial infarction and fatal CHD) during 20 years of follow-up, including 889 cases of fatal CHD and 1469 cases of nonfatal myocardial infarction. In a multivariate model adjusting for cardiovascular risk factors, overweight and obesity were significantly associated with increased risk of CHD, whereas increasing levels of physical activity were associated with a graded reduction in CHD risk (PϽ0.001). In joint analyses of body mass index (BMI) and physical activity in women who had a healthy weight (BMI, 18.5 to 24.9 kg/m 2 ) and were physically active (exercise Ն3.5 h/wk) as the reference group, the relative risks of CHD were 3.44 (95% confidence interval [CI], 2.81 to 4.21) for women who were obese (BMI Ն30 kg/m 2 ) and sedentary (exercise Ͻ1 h/wk), 2.48 (95% CI, 1.84 to 3.34) for women who were active but obese, and 1.48 (95% CI, 1.24 to 1.77) for women who had a healthy weight but were sedentary. In combined analyses of waist-hip ratio and physical activity, both waist-hip ratio and physical activity were significant predictors of CHD, and the highest risk was among women in the lowest category of physical activity and the highest tertile of waist-hip ratio (relative riskϭ3.03; 95% CI, 1.96 to 4.18). Even a modest weight gain (4 to 10 kg) during adulthood was associated with 27% (95% CI, 12% to 45%) increased risk of CHD compared with women with a stable weight after adjusting for physical activity and other cardiovascular risk factors. Conclusions-Obesity and physical inactivity independently contribute to the development of CHD in women. These data underscore the importance of both maintaining a healthy weight and regular physical activity in preventing CHD.

IMPORTANCE Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.

OBJECTIVE -Inflammation plays a key role in chronic obstructive pulmonary disease (COPD) and asthma. Increasing evidence points toward a role of inflammation in the pathogenesis of type 2 diabetes. We wanted to determine the relation of COPD and asthma with the development of type 2 diabetes. RESEARCH DESIGN AND METHODS -TheNurses' Health Study is a prospective cohort study. From 1988From -1996,614 female nurses were asked biennially about a physician diagnosis of emphysema, chronic bronchitis, asthma, and diabetes.RESULTS -During 8 years of follow-up, we documented a total of 2,959 new cases of type 2 diabetes. The risk of type 2 diabetes was significantly higher for patients with COPD than those without (multivariate relative risk 1.8, 95% CI 1.1-2.8). By contrast, the risk of type 2 diabetes among asthmatic patients was not increased (1.0, 0.8 -1.2). The asthma results remained nonsignificant even when we evaluated diabetes risk by duration of asthma exposure.CONCLUSIONS -Our findings suggest that COPD may be a risk factor for developing type 2 diabetes. Differences in the inflammation and cytokine profile between COPD and asthma might explain why COPD, but not asthma, is associated with increased risk of type 2 diabetes. Diabetes Care 27:2478 -2484, 2004C hronic inflammation has emerged as a new risk factor for the development of type 2 diabetes (1-3). Increasing evidence now points toward a role of proinflammatory cytokines such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-␣ in the pathogenesis of insulin resistance and type 2 diabetes (1-4). Due to the upregulation of proinflammatory cytokines in both asthma and chronic obstructive pulmonary disease (COPD) (5,6), one might hypothesize that these chronic inflammatory diseases would increase risk for type 2 diabetes.However, the pattern of inflammation for asthma and COPD differs (7). The cellular infiltrate in asthma contains prominent numbers of eosinophils and type 2 helper (Th2) CD4 T-cells and associated cytokines (IL-4, -5, and -13) (5). By contrast, the cellular infiltrate in COPD is dominated by neutrophils, macrophages, and an increased numbers of lymphocytes thought to be type 1 helper (Th1) or CD8 T-cells (8), and the neutrophilassociated cytokines (TNF-␣, IL-6, and IL-8) predominate (9). A recent report (10) from the Third National Health and Nutrition Examination Survey demonstrated that increasing severity of COPD was associated with increasing levels of CRP. Moreover, systemic inflammation in COPD is associated with increased muscle wasting and a continuous hypoxemic state due to destruction of lung tissue (11). Because of these inflammatory differences, the relationship of COPD or asthma with the development of another condition with an inflammatory component, such as type 2 diabetes, may vary. We therefore evaluated the association between a history of physiciandiagnosed COPD or asthma and incidence of type 2 diabetes among almost 100,000 participants in the Nurses' Health Study. We focused on potential ...

Background The accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk equation for atherosclerotic cardiovascular disease (ASCVD) events in contemporary and ethnically diverse populations is not well understood. Objectives We sought to evaluate the accuracy of the 2013 ACC/AHA risk equation within a large, multiethnic population in clinical care. Methods The target population for consideration of cholesterol-lowering therapy in a large, integrated health care delivery system population was identified in 2008 and followed through 2013. The main analyses excluded those with known ASCVD, diabetes mellitus, low-density lipoprotein cholesterol levels <70 or ≥190 mg/dl, prior statin use, or incomplete 5-year follow-up. Patient characteristics were obtained from electronic medical records and ASCVD events were ascertained using validated algorithms for hospitalization databases and death certificates. We compared predicted versus observed 5-year ASCVD risk, overall and by sex and race/ethnicity. We additionally examined predicted versus observed risk in patients with diabetes mellitus. Results Among 307,591 eligible adults without diabetes between 40 and 75 years of age, 22,283 were black, 52,917 Asian/Pacific Islander, and 18,745 Hispanic. We observed 2,061 ASCVD events during 1,515,142 person-years. In each 5-year predicted ASCVD risk category, observed 5-year ASCVD risk was substantially lower: 0.20% for predicted risk <2.50%; 0.65% for predicted risk 2.50 to 3.74%; 0.90% for predicted risk 3.75 to 4.99%; and 1.85% for predicted risk ≥5.00%, with C: 0.74. Similar ASCVD risk overestimation and poor calibration with moderate discrimination (C: 0.68 to 0.74) was observed in sex, racial/ethnic, and socioeconomic status subgroups, and in sensitivity analyses among patients receiving statins for primary prevention. Calibration among 4,242 eligible adults with diabetes was improved, but discrimination was worse (C: 0.64). Conclusions In a large, contemporary “real-world” population, the ACC/AHA Pooled Cohort risk equation substantially overestimated actual 5-year risk in adults without diabetes, overall and across sociodemographic subgroups.

COX-2 plays an important role in VEGF-induced angiogenesis via p38 and JNK kinase activation pathways. These findings suggest that the cardioprotective role of COX-2 may be, at least in part, through its angiogenic activity.

BackgroundEvidence supporting nonstatin lipid‐lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013.Methods and ResultsWe used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out‐of‐pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002‐2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012‐2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002‐2003 to 13.9% in 2012‐2013 after peaking at 20.3% in 2006‐2007. In 2012‐2013, 15.9% of high‐intensity statin users also used nonstatins, versus 9.7% of low/moderate‐intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75‐0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36‐0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40‐0.56). Total nonstatin expenditures increased from $1.7 billion (out‐of‐pocket cost, $0.7 billion) in 2002‐2003 to $7.9 billion (out‐of‐pocket cost $1.6 billion) in 2012‐2013, as per‐user nonstatin expenditure increased from $550 to $992. Nonstatin expenditure as a proportion of all lipid‐lowering therapy expenditure increased 4‐fold from 8% to 32%.ConclusionsBetween 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin‐associated expenditures.