Canadian Medical Association journal最新文献

{"title":"Clinical significance of low-density lipoprotein cholesterol percentage reduction and attained levels after percutaneous coronary intervention.","authors":"Danbee Kang, Ki Hong Choi, Seongwoo Yang, Hyunsoo Kim, Taek Kyu Park, Joo Myung Lee, Juhee Cho, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo-Yong Hahn","doi":"10.1503/cmaj.241713","DOIUrl":"https://doi.org/10.1503/cmaj.241713","url":null,"abstract":"<p><strong>Background: </strong>Differences exist between European and American guideline recommendations regarding targets for low-density lipoprotein cholesterol (LDL-C) levels after percutaneous coronary intervention (PCI), with European guidance advocating for more aggressive reduction to less than 1.4 mmol/L compared with the American guideline, which recommends an LDL-C level of 1.8 mmol/L or greater as the threshold for treatment intensification. We aimed to evaluate clinical outcomes according to percentage reduction of LDL-C levels and to compare the outcomes according to the attained LDL-C levels after PCI.</p><p><strong>Methods: </strong>This nationwide cohort study included adults in South Korea who underwent PCI and health screening within 3 years before and after PCI. Participants were divided into groups with a reduction of LDL-C levels of less than 50% and of 50% or greater. The group with LDL-C reduction of 50% or greater was stratified into categories of LDL-C level after PCI: less than 1.4 mmol/L, 1.4 to less than 1.8 mmol/L, and 1.8 mmol/L or greater. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, spontaneous myocardial infarction (MI), repeat revascularization, and ischemic stroke.</p><p><strong>Results: </strong>We included 135 877 adult participants. A total of 40.1% achieved a reduction of LDL-C levels of 50% or greater (<i>n</i> = 54 551). During a median follow-up of 7.4 years, the group with a reduction of 50% or greater had a multivariable-adjusted hazard ratio (HR) for MACCE of 0.78 (95% confidence interval [CI] 0.76-0.80). Among patients who achieved a reduction of LDL-C levels of 50% or greater, the multivariable-adjusted HR for MACCE was 1.07 (95% CI 1.02-1.13) for the group with LDL-C levels of 1.4 to less than 1.8 mmol/L after PCI and 1.12 (95% CI 1.04-1.21) for the group with levels of greater than 1.8 mmol/L. The risk of spontaneous MI was also higher in the group with LDL-C levels of 1.8 mmol/L or greater than in the group with levels of less than 1.4 mmol/L (HR 1.36, 95% CI 1.14-1.62).</p><p><strong>Interpretation: </strong>Among patients who underwent PCI, those who achieved a reduction in LDL-C levels of 50% or greater had a reduced risk of MACCE, regardless of baseline LDL-C levels. Among patients with a reduction in LDL-C levels of 50% or greater, compared with patients with an LDL-C level less than 1.4 mmol/L after PCI, those with an LDL-C level of greater than 1.8 mmol/L and a level of 1.4 to less than 1.8 mmol/L had an increased risk of MACCE. These findings suggest that while achieving an LDL-C reduction of 50% or greater remains a critical therapeutic goal, targeting LDL-C levels of less than 1.4 mmol/L after PCI may provide additional clinical benefit.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06338956.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E442-E452"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copper deficiency.","authors":"Reid C Gallant, Lita Cameron, Siraj Mithoowani","doi":"10.1503/cmaj.250072","DOIUrl":"https://doi.org/10.1503/cmaj.250072","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E456"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volunteer navigators to support people with life-limiting illness in the community.","authors":"Barbara Pesut, Gloria Puurveen, Kelly Ashford, Wendy Duggleby","doi":"10.1503/cmaj.241692","DOIUrl":"https://doi.org/10.1503/cmaj.241692","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E453-E455"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tout, sauf l’amour.","authors":"Diana Toubassi","doi":"10.1503/cmaj.241795-f","DOIUrl":"https://doi.org/10.1503/cmaj.241795-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E463-E464"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effets toxiques des anticorps bispécifiques.","authors":"Joanne Britto, Hira Mian, Gwynivere A Davies, Amaris K Balitsky","doi":"10.1503/cmaj.241384-f","DOIUrl":"https://doi.org/10.1503/cmaj.241384-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E459-E460"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"pause\" on the Canadian Task Force on Preventive Health Care is misguided.","authors":"Roland Grad, René Wittmer, Geneviève Bois, Yun Jen, Marc-André Gagnon","doi":"10.1503/cmaj.152288-l","DOIUrl":"https://doi.org/10.1503/cmaj.152288-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 16","pages":"E458"},"PeriodicalIF":9.4,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La maladie de Still de l’adulte.","authors":"Nickrooz Grami, Dalton R Budhram, Wayne L Gold","doi":"10.1503/cmaj.241321-f","DOIUrl":"https://doi.org/10.1503/cmaj.241321-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 15","pages":"E440-E441"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary angioedema.","authors":"Kelsey Uminski, Stephen Betschel, Dawn Goodyear","doi":"10.1503/cmaj.241815","DOIUrl":"https://doi.org/10.1503/cmaj.241815","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 15","pages":"E417-E418"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maladie des légionnaires acquise lors d’une baignade dans un lac de l’Iowa.","authors":"Ashley Bryson, Martha Shepertycky, Terence Wuerz, Philippe Lagacé-Wiens","doi":"10.1503/cmaj.241086-f","DOIUrl":"https://doi.org/10.1503/cmaj.241086-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 15","pages":"E435-E439"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author response to \"Why reduce frequency of print issues if they are well read?\"","authors":"Holly Bodger","doi":"10.1503/cmaj.152185-l","DOIUrl":"https://doi.org/10.1503/cmaj.152185-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 15","pages":"E422"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}