Atherosclerosis is an inflammatory disease. Because high plasma concentrations of cholesterol, in particular those of low-density lipoprotein (LDL) cholesterol, are one of the principal risk factors for atherosclerosis,1 the process of atherogenesis has been considered by many to consist largely of the accumulation of lipids within the artery wall; however, it is much more than that. Despite changes in lifestyle and the use of new pharmacologic approaches to lower plasma cholesterol concentrations,2,3 cardiovascular disease continues to be the principal cause of death in the United States, Europe, and much of Asia.4,5 In fact, the lesions of atherosclerosis represent . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM199901143400207

Atherosclerosis — An Inflammatory Disease

Atherosclerosis is an Inflammatory Disease

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

https://vascular.stanford.edu/content/dam/sm/vascular/documents/endovasc/guidelines/PIIS0741521406022968.pdf

Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

Add Indication for Coronary Stent as a Risk Factor for Poor Outcome Following Noncardiac Surgery.

chapter 21 – Splanchnic Artery Aneurysms


 Introduction:
 Traditionally, acute uncomplicated type-B aortic dissections (auTBAD) are managed with best medical therapy. Recent literature has focused on identifying high-risk patients who might benefit from early endovascular repair based on dissection anatomy characteristics, but socioeconomic factors are less often considered despite relationships between disparities and vascular disease outcomes.
 
 
 Aim:
 To understand the presentation, management, follow-up, and outcomes among patients presenting with auTBAD, focusing on insurance status.
 
 
 Methods:
 In this single center, observational study, demographics, medication prescription patterns, follow-up, and outcomes of patients with auTBAD managed medically from 2013-2018 were analyzed. Patients with complicated, chronic, type-A dissection, PAU, or IMH were excluded. Area deprivation index (ADI) was determined from patient’s home addresses. Comparisons between age, ADI, prescription patterns, follow-up, and outcomes were made between groups based on payer status. Payer status was defined as insured or self-pay (i.e., no insurance).
 
 
 Results:
 57 patients presented with auTBAD and were managed medically. 30% of patients were self-pay. Self-pay patients were from areas with higher deprivation indices (74 vs 62, p = 0.041), presented with higher blood pressures (138 vs. 118 mmHg, p = 0.006), and were on fewer home antihypertensives (0.29 vs 0.95, p = 0.030). Self-pay patients required more antihypertensives at discharge (3.6 vs 3.0, p = 0.049) and were less likely to follow-up (29% vs. 70%, p = 0.008). Self-pay patients had worse freedom from aortic intervention (p = 0.023), were more likely to represent urgently or emergently for repair (75% vs 0%, 0.033), and trended towards earlier time to intervention (8.5 months vs. 30 months, p = 0.060).
 
 
 Conclusions:
 Self-pay insurance was associated with worse hypertensive disease characteristics, follow-up patterns, and long-term outcomes in patients presenting with auTBAD managed with medical therapy. These findings suggest prohibitive compliance and surveillance trends in this cohort, which underscores the importance of considering patient factors, particularly payer status, when deciding between auTBAD treatment options.


Gilbert R. Upchurch

Papers

Add Indication for Coronary Stent as a Risk Factor for Poor Outcome Following Noncardiac Surgery.

chapter 21 – Splanchnic Artery Aneurysms

Abstract 11887: Self-Pay Insurance Status is Associated With Failure of Medical Therapy in Patients With Acute Uncomplicated Type B Aortic Dissection

Editorial: Using Accreditation Council for Graduate Medical Education case logs to understand differences in vascular surgery training paradigms.

National Treatment Patterns and Outcomes in Patients with End-stage Renal Disease and Chronic Limb-Threatening Ischemia