Abstract:
:Clinical guidelines for instituting pharmacotherapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), specifically lipid management and aspirin, have long been based on absolute risk. However, lipid management in the current era remains challenging to both patients and clinicians in the setting of somewhat discordant recommendations from various organizations. All guidelines endorse the use of statins for primary prevention for those at sufficient absolute risk, and treatment recommendations are generally "risk-based" rather than exclusively targeting specific low-density lipoprotein cholesterol levels. Nonetheless, guidelines differ in relation to the risk threshold for initiation and the intensity of statin treatment. The key concept of the clinician-patient risk discussion introduced in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines is a process that addresses the potential for ASCVD risk reduction with statin treatment, potential for adverse treatment effects, patient preferences, encouragement of heart-healthy lifestyle, and management of other risk factors. However, operationalizing the clinician-patient risk discussion requires effective communication of the most accurate and personalized risk information. In this article, we review our treatment approach for the appropriate use of coronary artery calcium testing in the intermediate-risk patient to guide shared decision making. The decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year ASCVD risk of 5% to 20%, and coronary artery calcium testing can reclassify risk upward or downward in approximately 50% of this group to inform the risk discussion. We conclude with 2 case-based examples of uncertain risk and uncertain statin therapeutic benefit to illustrate execution of the clinician-patient risk discussion.
journal_name
Mayo Clin Procjournal_title
Mayo Clinic proceedingsauthors
Michos ED,Blaha MJ,Blumenthal RSdoi
10.1016/j.mayocp.2017.10.001subject
Has Abstractpub_date
2017-12-01 00:00:00pages
1831-1841issue
12eissn
0025-6196issn
1942-5546pii
S0025-6196(17)30719-Xjournal_volume
92pub_type
杂志文章abstract::Clostridioides difficile infection (CDI) is the leading cause of health care-associated infections in the United States. The increasing incidence and recurrence rates of CDI together with its associated morbidity and mortality are great concerns. Newer treatment methods, such as narrow-spectrum antibiotics, monoclonal...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2019.08.006
更新日期:2020-04-01 00:00:00
abstract::Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2013.03.002
更新日期:2013-06-01 00:00:00
abstract::The toxic shock syndrome has only recently been described. Eleven female patients aged 13 to 43 years (median 17) with toxic shock syndrome have been seen at the Mayo Clinic since August 1975. One patient died. Seven patients had one or more recurrences. As previously described, the syndrome was often life-threatening...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-11-01 00:00:00
abstract::Risedronate sodium is a pyridinyl bisphosphonate effective for treatment and prevention of postmenopausal and glucocorticoid-induced osteoporosis. Some bisphosphonates have been associated with upper gastrointestinal (GI) tract adverse effects. The objective of this study was to determine the frequency of upper GI tra...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,meta分析
doi:10.4065/77.3.262
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVE:To examine the effects of interval walking training (IWT) on the estimated peak aerobic capacity (eV˙O2peak) and lifestyle-related disease (LSD) score while focusing on exercise intensity and volume in middle-aged and older people. PARTICIPANTS AND METHODS:Men and women (N=679; mean age, 65±7 SD years) compl...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2019.04.039
更新日期:2019-12-01 00:00:00
abstract::Anesthesia support for patients undergoing orthotopic liver transplantation can be complicated because of multiple medical problems in such patients and rapid hemodynamic, metabolic, and coagulation changes intraoperatively. Preoperative assessment should include careful review of the cardiovascular, respiratory, and ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65677-8
更新日期:1989-02-01 00:00:00
abstract::To identify the wishes of patients with amyotrophic lateral sclerosis (ALS) for information, participation in decision making, and life-sustaining therapy and to determine whether these wishes are stable over time, we conducted a prospective survey (baseline and 6-month follow-up interviews) of 38 consecutive patients...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61577-8
更新日期:1991-09-01 00:00:00
abstract::The first 100 liver transplantations at the Mayo Clinic were performed in 83 patients, who required a total of 917 patient days in the intensive-care unit (ICU). The mean duration of stay in the ICU was 5.91 days after liver transplantation and 6.15 days for patients who subsequently required readmission to the ICU. D...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65734-6
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:To determine the clinical characteristics of hospitalized patients who died of pulmonary embolism, confirmed by evaluative autopsy. DESIGN:We retrospectively analyzed a series of autopsy cases of pulmonary embolism at a tertiary-care center for the period Jan. 1, 1985, through Dec. 31, 1989. MATERIAL AND ME...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/70.5.417
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the treatment strategies for primary and secondary management of malignancy-related pericardial effusions. PATIENTS AND METHODS:Retrospective review of Mayo Clinic Rochester charts and external records of patients with pericardial effusion associated with malignant disease who required treatment ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/75.3.248
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To determine the percentage of metastatic and unexpected residual lung cancer at autopsy in patients considered for curative resection of non-small cell lung cancer during a time when computed tomography was available as a preoperative staging tool. MATERIAL AND METHODS:Clinical data and surgical and autopsy...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/79.11.1409
更新日期:2004-11-01 00:00:00
abstract::Mechanical and bioprosthetic mitral prostheses may have many potential complications. In patients with isolated mitral stenosis and a small left ventricular cavity, low-profile prostheses are recommended to avoid myocardial impingement that can result from a high-profile valve and lead to possible left ventricular inf...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60217-1
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:To describe clinical and laboratory findings from the 2012 southeastern Minnesota pertussis outbreak. PATIENTS AND METHODS:Patients were selected for 2 parts of the study. In the first part, nasopharyngeal swabs from a convenience sample of 265 unique patients were used for both the clinician-requested polym...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2014.08.004
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To examine whether the outcome of patients with primary systemic amyloidosis (AL) has improved over time and to identify predictors of early mortality in patients with AL. PATIENTS AND METHODS:We studied 2 separate cohorts of patients. The first cohort, consisting of 1998 patients with AL seen at Mayo Clinic...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/mcp.2010.0480
更新日期:2011-01-01 00:00:00
abstract:FINDINGS:The prostate-specific antigen (PSA) level alone does not facilitate precise pathologic staging on an individual basis, although advanced stage tends to correlate with an increased PSA level. The staging accuracy of PSA, however, can be enhanced by considering the variables of tumor grade and clinical stage. St...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)61615-2
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To report the long-term follow-up of a matched comparison of radical nephrectomy (RN) and nephron-sparing surgery (NSS) in patients with single unilateral renal cell carcinoma (RCC) and a normal contralateral kidney. PATIENTS AND METHODS:Between August 1966 and March 1999, 1492 and 189 patients with unilater...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/75.12.1236
更新日期:2000-12-01 00:00:00
abstract::A prospective, stratified, randomized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years. The goals for conventional glucose control were the mean of fast...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1983-05-01 00:00:00
abstract:OBJECTIVE:To comparatively assess the natural history of patients of different ages undergoing transcatheter aortic valve replacement (TAVR). PATIENTS AND METHODS:For this study, we used the YOUNG TAVR, an international, multicenter registry investigating mortality trends up to 2 years in patients with aortic valve st...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,多中心研究
doi:10.1016/j.mayocp.2019.01.008
更新日期:2019-08-01 00:00:00
abstract::The Human Genome Project has resulted in a new era in the field of pharmacogenetics in which researchers are rapidly discovering new genetic variation, which may help to explain interindividual variability in drug efficacy and toxicity. Pharmacogenetics is the study of the role of genetic inheritance in individual var...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/79.3.376
更新日期:2004-03-01 00:00:00
abstract::We describe a case of gastric metastasis from a lobular carcinoma of the breast in a 45-year-old woman who had undergone a left mastectomy with axillary dissection 7 years earlier. At the current presentation, she had been experiencing progressive epigastric discomfort for 3 months. The initial diagnosis was early gas...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/S0025-6196(11)63129-7
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVE:To ascertain the usefulness of bone marrow and cerebrospinal fluid (CSF) examinations in identifying or predicting relapse in children with acute lymphoblastic leukemia (ALL) before discontinuation of chemotherapy. MATERIAL AND METHODS:We retrospectively reviewed the medical records of 113 children with ALL ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/71.9.854
更新日期:1996-09-01 00:00:00
abstract::In ancient times, the sun was venerated as a source of life in some cultures. Scientifically, the relationship between vitamin D and sunlight and the deficiency of vitamin D in patients with rickets were ultimately discovered. In 1903, Niels Finsen was awarded the Nobel Prize in medicine or physiology for his "Finsen ...
journal_title:Mayo Clinic proceedings
pub_type: 历史文章,杂志文章
doi:10.4065/72.5.461
更新日期:1997-05-01 00:00:00
abstract::To determine factors associated with a favorable long-term prognosis in gastric leiomyosarcoma, we retrospectively reviewed the medical records of 93 Mayo Clinic patients with this biopsy-proven tumor diagnosed during the 25-year period from 1964 through 1988. Six patients who had Carney's triad (gastric epithelioid l...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60459-5
更新日期:1992-06-01 00:00:00
abstract::During the past 16 years, in which 1,600 patients were surgically treated for primary hyperparathyroidism, 10 of these patients also were operated on for hypernephroma; in another patient a hypernephroma was detected 7 2/3 years after treatment for hyperparathyroidism. Four additional patients have elevated serum calc...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1982-11-01 00:00:00
abstract::In a group of 47 patients with mediastinal granulomas, the most common clinical symptoms were cough, chest pain, dysphagia, hemoptysis, and dyspnea. The main laboratory findings were right paratracheal or hilar mass on chest roentgenogram, positive histoplasmin skin test, and caseating granuloma on histopathologic exa...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1975-12-01 00:00:00
abstract::Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out usin...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2017.01.002
更新日期:2017-03-13 00:00:00
abstract::Giant cell arteritis and polymyalgia rheumatica were described separately more than 100 years ago. However, the original reports of both conditions were neglected for many years. After the article by Horton et al on giant cell arteritis in the 1930s and studies published by others in the 1940s, giant cell arteritis be...
journal_title:Mayo Clinic proceedings
pub_type: 历史文章,杂志文章
doi:10.4065/81.8.1071
更新日期:2006-08-01 00:00:00
abstract::Acute disseminated encephalomyelitis, an inflammatory demyelinating disease of the central nervous system, can occur after viral infections or vaccinations. We report the clinical and neuroimaging findings in a 52-year-old man in whom acute disseminated encephalomyelitis developed after accidental self-injection of an...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/73.12.1193
更新日期:1998-12-01 00:00:00
abstract::Two-dimensional echocardiography is useful for the immediate diagnosis of acute myocardial infarction when diagnostic electrocardiographic changes are absent. The technique is also helpful in distinguishing myocardial infarction from other conditions that may clinically or electrocardiographically mimic infarction. Th...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61526-2
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:To examine current therapeutic modalities for acute lymphocytic leukemia (ALL) in adults, analyze prognostic variables, and offer treatment recommendations. DESIGN:We reviewed our experience with 90 adult patients with ALL examined at the Mayo Clinic between 1982 and 1992 and used it as a background for disc...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61817-5
更新日期:1994-10-01 00:00:00