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Switching from Insulin to Dulaglutide Therapy in Patients with Type 2 Diabetes: A Real-World Data Study.

Diabetes Metab Res Rev 2021 May 6. Epub 2021 May 6.

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Aim: Patients with type 2 diabetes (T2DM) who require injectable therapy have been conventionally treated with insulin. A glucagon-like peptide 1 receptor agonist was recently recommended as first line injectable treatment, but few studies have investigated the effects of switching from insulin to dulaglutide. This study investigated the clinical efficacy and parameters affecting responses to dulaglutide as an alternative to insulin in patients with T2DM in a real-world clinical setting. Read More

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The Predictive Value of Decisive and Soft Ultrasound Criteria for Ectopic Pregnancy Identification in 321 Preoperative Cases.

Ultraschall Med 2021 May 6. Epub 2021 May 6.

Department of Gynecology, University Hospital Zürich, Switzerland.

Purpose:  To define the predictive value of morphological types (MTs) and further criteria in diagnosing ectopic pregnancy (ECP) by transvaginal sonography (TVS) prior to operative confirmation and treatment.

Materials And Methods:  Retrospective cohort analysis of 321 consecutive patients with suspected ECP who were advised to undergo operation.

Results:  ECP was investigated by TVS in all 321 patients. Read More

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[Interdisciplinary aspects of oral anticoagulation with NOACs in atrial fibrillation].

Dtsch Med Wochenschr 2021 May 6;146(S 01):S2-S16. Epub 2021 May 6.

Kardiologie, Universitäts-Herzzentrum Freiburg.

Stroke prophylaxis with non-vitamin K-dependent oral anticoagulants (NOAKs) in patients with non-valvular atrial fibrillation (nvVHF) is now firmly established in routine clinical practice. The definition of nvVHF includes the absence of a mechanical heart valve and AF not associated with moderate- or high-grade mitral valve stenosis. The management of oral anticoagulation (OAC) requires a high degree of interdisciplinarity. Read More

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Middle Meningeal Artery Embolization of a Pediatric Patient With Progressive Chronic Subdural Hematoma.

Oper Neurosurg (Hagerstown) 2021 May 6. Epub 2021 May 6.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Background And Importance: Evidence suggests middle meningeal artery (MMA) embolization benefits adult patients with chronic subdural hematoma (CSDH) at high risk for recurrence or hemorrhagic complications. Yet, there has not been any report discussing MMA embolization in the pediatric population. Thus, we present a case of an infant with CSDH successfully managed with MMA embolization without surgical management. Read More

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Investigating the material modelling of a polymeric bioresorbable scaffold via in-silico and in-vitro testing.

J Mech Behav Biomed Mater 2021 Apr 23;120:104557. Epub 2021 Apr 23.

Computational Engineering and Design Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK. Electronic address:

The accurate material modelling of poly-l-lactic acid (PLLA) is vital in conducting finite element analysis of polymeric bioresorbable scaffolds (BRS) to investigate their mechanical performance and seek improved scaffold designs. To date, a large variety of material models have been utilised, ranging from simple elasto-plastic models to high fidelity parallel network models. However, no clear consensus has been reached on the appropriateness of these different models and whether simple, less computationally expensive models can serve as acceptable approximations. Read More

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A 3D personalized cardiac myocyte aggregate orientation model using MRI data-driven low-rank basis functions.

Med Image Anal 2021 Apr 9;71:102064. Epub 2021 Apr 9.

Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland. Electronic address:

Cardiac myocyte aggregate orientation has a strong impact on cardiac electrophysiology and mechanics. Studying the link between structural characteristics, strain, and stresses over the cardiac cycle and cardiac function requires a full volumetric representation of the microstructure. In this work, we exploit the structural similarity across hearts to extract a low-rank representation of predominant myocyte orientation in the left ventricle from high-resolution magnetic resonance ex-vivo cardiac diffusion tensor imaging (cDTI) in porcine hearts. Read More

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Ecotoxicological effects of pyraclostrobin on tilapia (Oreochromis niloticus) via various exposure routes.

Environ Pollut 2021 Apr 28;285:117188. Epub 2021 Apr 28.

Shandong Provincial Key Laboratory for Biology of Vegetable Diseases and Insect Pests, Shandong Agricultural University, Tai'an, Shandong, 271018, PR China; College of Plant Protection, Shandong Agricultural University, Tai'an, Shandong, 271018, PR China. Electronic address:

Pyraclostrobin is a widely used and highly efficient fungicide that also has high toxicity to aquatic organisms, especially fish. Although some research has reported the toxic effects of pyraclostrobin on fish, the main toxic pathways of pyraclostrobin in fish remain unclear. The present study has integrated histopathological, biochemical and hematological techniques to reveal the main toxic pathways and mechanisms of pyraclostrobin under different exposure routes. Read More

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A comprehensive formula for computing corrected QT intervals in patients with wide QRS.

J Electrocardiol 2021 Apr 17;66:139-147. Epub 2021 Apr 17.

Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain. Electronic address:

Background: There is increasing interest in developing appropriate methods for correction of the QT intervals in patients with prolonged depolarization of the ventricles. From an experimental model of controlled heart rate and QRS widening, we aimed to develop a new formula with better performance.

Methods: After exclusions, incremental pacing was performed (AAI mode; 50-120 bpm) in 17 patients admitted for self-expanding aortic valve implantation in two different phases: before and immediately after the release of the prosthesis. Read More

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Projectile vomiting and Valsalva-like abdominal contractions as an uncommon presentation of supraventricular tachycardia in an infant.

J Electrocardiol 2021 Apr 22;66:136-138. Epub 2021 Apr 22.

Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy.

Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential diagnosis essential in not delaying crucial intervention. We here describe the case of an undetected PSVT in an infant performing repeated abdominal contractions, thus presenting with projectile vomiting. Read More

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Non-target bioanalytical eight-dimensional hyphenation including bioassay, heart-cut trapping, online desalting, orthogonal separations and mass spectrometry.

J Chromatogr A 2021 Apr 20;1647:462154. Epub 2021 Apr 20.

Chair of Food Science, Institute of Nutritional Science, and Interdisciplinary Research Center (iFZ), Justus Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany. Electronic address:

It is still a challenge to discover and identify individual bioactive compounds directly in multicomponent mixtures. Current workflows are too tedious for routine use. Hence, the hyphenation of separation and detection techniques is a powerful tool to maximize the information obtained by a single sample run. Read More

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Impact of coronary risk scores on disposition decision in emergency patients with chest pain.

Am J Emerg Med 2021 Apr 14;48:165-169. Epub 2021 Apr 14.

Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address:

Background: Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain.

Objective: This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED. Read More

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The precordial R'-wave: a novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia.

Heart Rhythm 2021 May 3. Epub 2021 May 3.

Department of Cardiology, Willem Einthoven Center of Arrhythmia research and Management, Leiden University Medical Center, The Netherlands. Electronic address:

Background: Cardiac sarcoidosis (CS) with right ventricular (RV) involvement can mimic arrhythmogenic right ventricular cardiomyopathy (ARVC). Histopathological differences may result in disease-specific RV activation patterns, detectable on the 12-lead electrocardiogram (ECG). Dominant subepicardial scar in ARVC leads to delayed activation of areas with reduced voltages, translating into terminal activation delay and occasionally (epsilon) waves with small amplitude. Read More

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Two P waves followed by one QRS complex: What is the mechanism?

Heart Rhythm 2021 May 3. Epub 2021 May 3.

Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, CA. Electronic address:

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A novel Ventricular map of Electrograms DUration as a Method to identify areas of slow conduction for ventricular tachycardia ablation. The VEDUM pilot study.

Heart Rhythm 2021 May 3. Epub 2021 May 3.

Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy.

Background: Bipolar EGM duration is indicative of local activation property and, if prolonged, is useful to discover areas of slow conduction favoring arrhythmias.

Objective: This study aimed to create a map of EGM duration during the VT (VEDUM Map) to verify if the area with the slowest activation is crucial for reentry and could represent a suitable target for rapid VT interruption during ablation.

Methods: Prospectively 30 patients (pts) were enrolled for this study. Read More

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A randomized placebo-control trial of the acute effects of oxygen supplementation on exercise hemodynamics, autonomic modulation, and brain oxygenation in patients with pulmonary hypertension.

Respir Physiol Neurobiol 2021 May 3:103677. Epub 2021 May 3.

Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Greece.

Background: The integrative physiological effects of O treatment on patients with pulmonary hypertension (PH) during exercise, have not been fully investigated. We simultaneously evaluated, for the first time, the effect of oxygen supplementation on hemodynamic responses, autonomic modulation, tissue oxygenation, and exercise performance in patients with pulmonary arterial hypertension (PAH)/Chronic Thromboembolic PH(CTEPH).

Material-methods: In this randomized, cross-over, placebo-controlled trial, stable outpatients with PAH/CTEPH underwent maximal cardiopulmonary exercise testing, followed by two submaximal trials, during which they received supplementary oxygen (O) or medical-air. Read More

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Reference Ranges for the Pulsed wave Doppler of the Fetal Cardiac Inflow and Outflow Tracts from 13 to 36 Weeks Gestation: Short title: Zidere, Fetal inflow and outflow tract, Pulsed wave Doppler, z scores.

J Am Soc Echocardiogr 2021 May 3. Epub 2021 May 3.

Medway Fetal and Maternal Medicine Centre, Medway Maritime Hospital, Gillingham, Kent, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Rowan William's Court, Chatham, Kent ME4 4UF.

Objective: Doppler assessment ventricular filling and outflow tract velocities are an integral part of the fetal echocardiogram, to assess diastolic function, systolic function and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. We report reference ranges for pulsed wave Doppler flow of the mitral valve, tricuspid valve, aortic valve and pulmonary valve as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology centre. Read More

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Changes in Plasma Renin Activity after Renal Artery Sympathetic Denervation.

J Am Coll Cardiol 2021 Apr 22. Epub 2021 Apr 22.

SUNY Downstate College of Medicine, Brooklyn, NY, USA.

Background: The renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several anti-hypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP.

Objectives: To evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN. Read More

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Utilization and outcomes of transesophageal echocardiography in 1.3 million CABG procedures.

J Am Coll Cardiol 2021 Apr 28. Epub 2021 Apr 28.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.

Background: Utilization of intraoperative transesophageal echocardiography (TEE) at time of isolated coronary artery bypass grafting (CABG), impact on clinical decision making and associated outcomes are not well understood.

Objective: To determine the association of TEE with post-CABG mortality and changes to the operative plan.

Methods: We performed a retrospective cohort study of planned isolated CABG patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database between January 1, 2011 and June 30, 2019. Read More

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Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention.

J Am Coll Cardiol 2021 Apr 28. Epub 2021 Apr 28.

Department of Medicine (Cardiology), University of North Carolina, Chapel Hill, NC. Electronic address:

Background: Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCI). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients.

Objectives: We sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables. Read More

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Carotid Artery Duplex Velocity Criteria May Be Equivocal After Left Ventricular Assist Device Implantation.

J Vasc Surg 2021 May 3. Epub 2021 May 3.

Division of Vascular Surgery, Department of Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University, College of Medicine, Hershey, PA. Electronic address:

Introduction: While conventional angiography remains the gold standard for the grading of carotid stenosis, carotid duplex ultrasound (CDUS) is the most commonly used modality for determining degree of carotid stenosis. The validity of CDUS in the left ventricular assist device (LVAD) patient population is questionable, as velocities are often altered secondary to the continuous-flow nature of the devices.

Methods: Retrospective review was performed on all patients who had undergone LVAD implantation between January 2007 and December 2019. Read More

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The role and mechanism of Hyperoside against myocardial infarction in mice by regulating autophagy via NLRP1 inflammation pathway.

J Ethnopharmacol 2021 May 3:114187. Epub 2021 May 3.

Department of Pharmacology, School of Basic Medicine, Anhui Medical University, No.81 Meishan Road, Hefei, 230032, People's Republic of China. Electronic address:

Ethnopharmacological Relevance: The genus Hypericum are widely distributed in China. Hypericum perforatum L. (genus Hypericum, family Hypericaceae) has a long history as a traditional Chinese medicine, which was traditionally used for the treatment of emotional distress, cardiothoracic depression, and acute mastitis. Read More

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Risk stratification of cardiovascular complications using CHADS-VASc and CHADS scores in chronic atherosclerotic cardiovascular disease.

Int J Cardiol 2021 May 3. Epub 2021 May 3.

Cardiology Research Unit, University Hospital Geelong, Barwon Health, Geelong, Australia.

Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). We explored whether CHADS-VASc or CHADS scores, well-validated tools for assessing risk of thromboembolic events in atrial fibrillation, can identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. Methods Predictive accuracies of the CHADS-VASc and CHADS scores for MACE, were assessed in this analysis of the COMPASS trial. Read More

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Heart failure management; a perspective from diabetes care.

Diabetes Res Clin Pract 2021 May 3:108849. Epub 2021 May 3.

Newcastle University, Newcastle upon Tyne, UK.

People with type 2 diabetes (T2DM) are recognized as having a 2-4 times increased risk of heart failure (HF). Ambulatory diabetes care has long concentrated on the prevention of microvascular and arterial disease, and surveillance for manageable problems such as with the feet and retinae. Accordingly, management of heart failure has never been a specific focus, although the preventative management of cardiac and kidney disease through glucose-lowering, blood pressure (BP) control, and blood lipid control have had a positive impact on its incidence. Read More

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Treating heart failure in patients with diabetes: the view of the cardiologist.

Diabetes Res Clin Pract 2021 May 3:108852. Epub 2021 May 3.

Medical Clinic I - Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany.

Diabetes is a very important comorbidity in patients with heart failure. When both diseases coexist cardiovascular morbidity and mortality is greatly increased. Therefore, it is of clinical importance to treat both diseases as early as possible with an optimal therapy. Read More

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Interdisciplinary assessment and diagnostic algorithm: the role of the cardiologist.

Diabetes Res Clin Pract 2021 May 3:108851. Epub 2021 May 3.

St George's Hospital Medical School, London, United Kingdom; IRCCS San Raffaele Roma; St Heliers and Epsom Hospital.

Patients with diabetes have an increased risk of developing heart failure and those with heart failure are at higher risk of developing diabetes. In patients with diabetes antidiabetic medications and the metabolic alterations of diabetes increase the risk of developing heart failure. In diabetic patients with heart failure and in those with an increased likelihood of developing the disease a stepwise approach based on the use of natriuretic peptides and echocardiography to rule out the presence of heart failure should be used. Read More

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Interdisciplinary assessment and diagnostic algorithm: the role of the diabetologist.

Nebojsa M Lalic

Diabetes Res Clin Pract 2021 May 3:108850. Epub 2021 May 3.

Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotica str. no 13, 11000 Belgrade, Serbia.

In recent years, many studies have revealed the importance of heart failure (HF) development in type 2 diabetes (T2D), which increases the morbidity and mortality during the course of diabetes. In this context, it became important to emphasize the role of both cardiologists and diabetologists in the early diagnosis and further adequate treatment of HF in T2D. While HF appears in two major forms, with reduced or preserved ejection fraction (EF), namely HFrEF and HFpEF, it became important to define the optimal approach to the diagnostics. Read More

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Opposing roles of E3 ligases TRIM23 and TRIM21 in regulation of ion channel ANO1 protein levels.

J Biol Chem 2021 May 3:100738. Epub 2021 May 3.

Division of Life Science, Hong Kong University of Science and Technology, Hong Kong; Department of Chemical and Biological Engineering, Hong Kong University of Science and Technology, Hong Kong; State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong; HKUST Shenzhen Research Institute, Hong Kong University of Science and Technology, Hong Kong; Hong Kong Branch of Guangdong Southern Marine Science and Engineering Laboratory (Guangzhou), Hong Kong University of Science and Technology, Hong Kong. Electronic address:

ANO1 (TMEM16A) is a calcium-activated chloride channel that plays critical roles in diverse physiological processes, such as sensory transduction and epithelial secretion. ANO1 levels have been shown to be altered under physiological and pathological conditions, although the molecular mechanisms that control ANO1 protein levels remain unclear. The ubiquitin-proteasome system is known to regulate the levels of numerous ion channels, but little information is available regarding whether and how ubiquitination regulates levels of ANO1. Read More

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Targeted truncation of the ADAM17 cytoplasmic domain in mice results in protein destabilization and a hypomorphic phenotype.

J Biol Chem 2021 May 3:100733. Epub 2021 May 3.

Physiology, Biophysics and Systems Biology Program, Weill Cornell Medicine, New York, NY, 10021, USA; Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, NY, 10021, USA; Institute for Advanced Study, Technische Universität München, D-85748 Garching, Germany; Department of Medicine, Physiology and Systems Biology, Weill Cornell Medicine, New York, NY, 10021, USA; Department of Biophysics, Physiology and Systems Biology, Weill Cornell Medicine, New York, NY 10021, USA. Electronic address:

A disintegrin and metalloprotease 17 (ADAM17) is a cell-surface metalloprotease that serves as the principle sheddase for Tumor necrosis factor α (TNFα), interleukin-6 receptor (IL-6R) and several ligands of the epidermal growth factor receptor (EGFR), regulating these crucial signaling pathways. ADAM17 activation requires its transmembrane domain, but not its cytoplasmic domain, and little is known about the role of this domain in vivo. To investigate, we used CRISPR-Cas9 to mutate the endogenous Adam17 locus in mice to produce a mutant ADAM17 lacking its cytoplasmic domain (Adam17Δcyto). Read More

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Translational investigation of electrophysiology in hypertrophic cardiomyopathy.

J Mol Cell Cardiol 2021 May 3. Epub 2021 May 3.

Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany. Electronic address:

Hypertrophic cardiomyopathy (HCM) patients are at increased risk of ventricular arrhythmias and sudden cardiac death, which can occur even in the absence of structural changes of the heart. HCM mouse models suggest mutations in myofilament components to affect Ca homeostasis and thereby favor arrhythmia development. Additionally, some of them show indications of pro-arrhythmic changes in cardiac electrophysiology. Read More

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The Impact of a Population-based Prevention Program on Cardiovascular Events: Findings from the Heart of New Ulm Project.

Am Heart J 2021 May 3. Epub 2021 May 3.

Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN; Minneapolis Heart Institute, 920 East 28th Street, Suite 300, Minneapolis, MN.

Background: Cardiovascular disease (CVD) and its associated risk factors are the principal drivers of mortality and healthcare costs in the United States with rural residents experiencing higher CVD death rates than their urban counterparts.

Methods: The purpose of this study was to examine incidence of major CVD events over 9 years of implementation of the Heart of New Ulm (HONU) Project, a rural population-based CVD prevention initiative. HONU interventions were delivered at individual, organizational, and community levels addressing clinical risk factors, lifestyle behaviors and environmental changes. Read More

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