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Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity
Purpose of ReviewWe sought to examine the role of social and environmental conditions that determine an individual’s behaviors and risk of disease—collectively known as social determinants of health (SDOH)—in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US).Recent FindingsTraditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework.SummaryWe examined existing evidence of the association between SDOH—organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context—and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.
Journal Article
Testing business ideas
\"There is a large knowledge gap in the market today between business strategy and experimentation. People resort to reading growth hacker blogs or going to meetups or eventually asking consultants for help. This book contains a library of techniques and specific guidance on how to rapidly test new business ideas in the market with customers, using the world renowned Business Model Canvas. The book has three parts. The first explains how Lean Experiments dramatically reduce risk and increase the likelihood of success for any new business idea. The second part introduces Assumptions Mapping and an experiment library. The third part defines a series of ceremonies and team configurations to make experimentation a continuous, repeatable process. The book concludes with a challenge to founders and executives on how to encourage an experimentation mindset within their organizations\"-- Provided by publisher.
Book
Highlights of Cardiovascular Disease Prevention Studies Presented at the 2022 American College of Cardiology Scientific Sessions
Purpose of ReviewFocused review highlighting select studies presented at the 2022 American College of Cardiology (ACC) Scientific Sessions.Recent FindingsIncluded studies assessed the impact of a low-sodium diet on heart failure outcomes (SODIUM-HF); outcomes of pregnant patients with chronic hypertension treated with antihypertensive therapies (CHAP); cardiovascular outcomes in patients with type 2 diabetes and renal impairment treated with sotagliflozin (SCORED); a safety and efficacy study investigating SLN360, a short interfering RNA targeting lipoprotein(a) (APOLLO); a supermarket and web-based intervention targeting nutrition for cardiovascular risk reduction (SuperWIN); a superiority trial comparing myocardial injury following very mild perioperative hypothermia versus aggressive warming after non-cardiac surgery (PROTECT); and 3-year efficacy outcomes of renal denervation on blood pressure reduction from the SPYRAL HTN-ON MED pilot study.SummaryResearch presented at the 2022 ACC Scientific Sessions underscores the new potential and meaningful impact of cardiovascular disease prevention and management interventions.
Journal Article
Highlights of Cardiovascular Disease Prevention Studies Presented at the 2022 European Society of Cardiology Congress
Purpose of ReviewFocused review of select studies presented at the 2022 European Society of Cardiology Congress.Recent FindingsIncluded studies assessed the effects of aspirin and omega-3 fatty acid supplements on heart failure (ASCEND study); the impact of icosapent ethyl on ST-elevation MI incidence (REDUCE-IT); air temperature’s effect on cardiovascular mortality (EXHAUSTION project); LVEF outcomes after troponin-guided neurohormonal blockade for the prevention of anthracycline toxicity; efficacy of routine stress testing after high-risk PCI (POST-PCI trial); influenza vaccine among patients with acute coronary syndromes (VIP-ACS trial); empagliflozin in patients with acute myocardial infarction (EMMY); effects of comprehensive imaging-based cardiovascular screening on death and cardiovascular events (DANCANVAS); safety of long-term evolocumab in patients with established atherosclerotic cardiovascular disease (FOURIER-OLE); and use of a cardiovascular polypill as a global strategy to improve secondary prevention (SECURE).SummaryResearch presented at the 2022 ESC Congress highlighted many novel applications of preventative and treatment strategies in cardiology, including the effects of environmental risk factors on the incidence of cardiovascular disease.
Journal Article
A light in dark times : the New School for Social Research and its University in Exile
\"Founded in 1919 in the name of academic freedom, the New School for Social Research quickly became a pioneer in adult education--what its first president, Alvin Johnson, called \"the continuing education of the educated.\" During the 1920s, the New School became the place to go to hear famous people lecture on politics, the arts, and recent developments in new fields of inquiry such as anthropology and psychoanalysis. In 1933 Johnson opened the University in Exile within the New School, providing visas and jobs for nearly two hundred refugees fleeing Hitler. And through these exiled scholars, he re-created in miniature the great intellectual traditions of Europe's imperiled universities. In this book, Judith Friedlander reconstructs the history of the New School in the context of ongoing debates over academic freedom, intellectual dissidents, and democratic education. Against the backdrop of World War I and the first Red Scare, the Hitler years and McCarthyism, the student uprisings during the Vietnam War and the downfall of communism in Eastern Europe, Friedlander tells a dramatic story of academic, political, and financial struggle through brief sketches of New School administrators, faculty members, trustees, and students, among them Alvin Johnson and the political philosopher Hannah Arendt. As this unique educational institution prepares to celebrate its one hundredth anniversary, A Light in Dark Times offers a timely reflection on the New School's legacy, which can serve as an inspiration for the academic community today\"-- Provided by publisher.
Book
Highlights from Studies Presented at the Virtual American College of Cardiology Scientific Sessions 2021: Staying Updated with the Latest Advancements in Prevention
Purpose of ReviewThis review highlights late-breaking science presented at the Virtual American College of Cardiology Scientific Sessions 2021 that demonstrated advancements in preventative cardiology and introduced novel therapeutic modalities for the management of chronic kidney disease, heart failure, and COVID-19.Recent FindingsThe studies reviewed include clinical trials that assessed the use of dapagliflozin in patients with respiratory failure due to COVID-19 (DARE-19 trial); evinacumab for patients with severe hypertriglyceridemia and pancreatitis; effect of genotype-guided oral P2y12 inhibitors vs conventional clopidogrel on long-term ischemic outcomes after percutaneous coronary intervention (TAILOR-PCI trial); anticoagulation in patients hospitalized with COVID-19 (ACTION trial); atorvastatin vs placebo in patients with COVID-19 admitted to the ICU (INSPIRATION-S trial); rehabilitation therapy in older acute heart failure patients (REHAB-HF trial); and aspirin dosing: a patient-centric trial assessing benefits and long-term effectiveness (ADAPTABLE trial). In addition, we review the results of the American College of Cardiology Global Heart Attack Initiative (GHATI). Finally, we discuss the secondary analysis of the STRENGTH trial assessing the association of achieved levels of omega-3 fatty acid levels and major cardiovascular outcomes.SummaryThe studies presented at the virtual American College of Cardiology Scientific Session 2021 represent remarkable contributions in the field of cardiovascular disease and prevention.
Journal Article
Nightshining
\"A braided memoir about flooding in the Catskills, the region's history regarding GE and cloud seeding, and the author's personal experiences.\"-- Provided by publisher.
BOOK
Highlights from Studies in Cardiovascular Disease Prevention Presented at the Digital 2020 European Society of Cardiology Congress: Prevention Is Alive and Well
Purpose of ReviewThe review highlights selected studies related to cardiovascular disease (CVD) prevention that were presented at the 2020 European Society of Cardiology (ESC) Congress—The Digital Experience.Recent FindingsThe studies reviewed include clinical trials on novel RNA interference-based lipid-lowering therapies AKCEA-APOCIII-LRx and vupanorsen (AKCEA-ANGPTL3-LRx); the EVAPORATE trial assessing the effects of icosapent ethyl on coronary plaque volume progression; the LoDoCo2 trial evaluating the efficacy of low-dose colchicine in cardiovascular disease risk reduction among patients with chronic coronary artery disease; as well as the EMPEROR-Reduced trial evaluating cardiovascular and renal outcomes with empagliflozin in patients with heart failure and reduced ejection fraction. In addition, we review the BPLTTC analysis on blood pressure treatment across blood pressure levels and CVD status and discuss findings from the BRACE CORONA study that examined continuing versus suspending angiotensin-converting enzyme inhibitor or angiotensin receptor blockers in patients on these antihypertensive medications who were hospitalized with COVID-19 infection.SummaryThe studies presented at the 2020 digital ESC Congress highlight the continuing advancements in the field of CVD prevention.
Journal Article