Regional Variations in Medication Usage for Cardiovascular Diseases at the Community Level in China (PURE-China Study)

We investigated the usage of secondary prevention drugs and traditional Chinese medicine （TCM） products in individuals with cardiovascular diseases （CVDs） at the community level in China. Among 2,407 participants with self-reported coronary heart disease （CHD） and 872 with stroke, nearly 80% of individuals with CHD and 73% of individuals with stroke were not taking any proven secondary prevention drug. However, 32.9% of them took TCM products. Patients with CVDs in rural areas used less secondary prevention treatment, but more TCM products than their counterparts in the urban regions. After adjusting for confounding factors, lower rates of secondary prevention treatment were evident in Western China compared with Eastern China, which was more developed. Systematic change is needed to promote the development of evidence-based medicine at the community level in China.

Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease(GCKD)cohort

Mineral and bone disorder(MBD)in chronic kidney disease(CKD)is tightly linked to cardiovascular disease(CVD).In this study,we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular(CV)outcomes and mortality.In 5217 participants of the German CKD(GCKD)study enrolled with an estimated glomerular filtration rate(eG FR)between 30–60 mL·min-1 per 1.73 m2 or overt proteinuria,serum osteoprotegerin(OPG),C-terminal fibroblast growth factor-23(FGF23),intact parathyroid hormone(iP TH),bone alkaline phosphatase(BAP),cross-linked C-telopeptide of type 1 collagen(CTX1),procollagen 1intact N-terminal propeptide(P1NP),phosphate,calcium,and 25-OH vitamin D were measured at baseline.Participants with missing values among these parameters(n=971)were excluded,leaving a total of 4246 participants for analysis.During a median follow-up of6.5 years,387 non-CV deaths,173 CV deaths,645 nonfatal major adverse CV events(MACEs)and 368 hospitalizations for congestive heart failure(CHF)were observed.OPG and FGF23 were associated with all outcomes,with the highest hazard ratios(HRs)for OPG.In the final Cox regression model,adjusted for CV risk factors,including kidney function and all other investigated biomarkers,each standard deviation increase in OPG was associated with non-CV death(HR 1.76,95%CI:1.35–2.30),CV death(HR 2.18,95%CI:1.50–3.16),MACE(HR 1.38,95%CI:1.12–1.71)and hospitalization for CHF(HR 2.05,95%CI:1.56–2.69).Out of the nine biomarkers examined,stratification based on serum OPG best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

Expert Consensus on Nutritional Support for Children with Congenital Heart Disease(2023 Edition)

The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the results of multi-center clinical nutrition research for congenital heart disease following thefirst Chinese consensus edition of 2016.The consensus was also shaped by the results of three discussion sessions and two questionnaires con-ducted by the 13-member collaboration group.This process was informed by both clinical guidelines and expert consensus.The quality of literature,both in English and Chinese,and the level of recommendations were evaluated using the Grading of Recommendations Assessment,Development,and Evaluations(GRADE)system.

The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events

Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2)and the risk of cardiovascular events in a Chinese population,with a long-term follow-up.Methods A random sample of 2,031 participants(73.6%males,mean age=60.4 years)was derived from the Asymptomatic Polyvascular Abnormalities Community study(APAC)from 2010 to 2011.Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay(ELISA).The composite endpoint was a combination of first-ever stroke,myocardial infarction(MI)or all-cause death.Lp-PLA2 associations with outcomes were assessed using Cox models.Results The median Lp-PLA2 level was 141.0 ng/m L.Over a median follow-up of 9.1 years,we identified 389 events(19.2%),including 137 stroke incidents,43 MIs,and 244 all-cause deaths.Using multivariate Cox regression,when compared with the lowest Lp-PLA2 quartile,the hazard ratios with95%confidence intervals for developing composite endpoints,stroke,major adverse cardiovascular events,and all-cause death were 1.77(1.24–2.54),1.92(1.03–3.60),1.69(1.003–2.84),and 1.94(1.18–3.18)in the highest quartile,respectively.Composite endpoints in 145(28.6%)patients occurred in the highest quartile where Lp-PLA2(159.0 ng/m L)was much lower than the American Association of Clinical Endocrinologists recommended cut-off point,200 ng/m L.Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population.The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Diagnosis and management of ischemic cardiomyopathy: Role of cardiovascular magnetic resonance imaging

Coronary artery disease(CAD) represents an important cause of mortality. Cardiovascular magnetic resonance(CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential diagnosis of acute chest pain by detecting the location of obstructive CAD or necrosis and identifying other conditions like stress cardiomyopathy or myocarditis that can present with acute chest pain. Besides, it underlines the prognostic implication of perfusion abnormalities in the setting of acute chest pain. Furthermore, the review addresses the role of CMR to detect significant CAD in patients with stable CAD. It elucidates the accuracy and clinical utility of CMR with respect to other imaging modalitieslike single-photon emission computed tomography and positron emission tomography. Besides, the prognostic value of CMR stress testing is discussed. Additionally, it summarizes the available CMR techniques to assess myocardial viability and describes algorithm to identify those patient who might profit from revascularization those who should be treated medically. Finally, future promising imaging techniques that will provide further insights into the fundamental disease processes in ischemic cardiomyopathy are discussed.

Left atrial physiology and pathophysiology:Role of deformation imaging

The left atrium(LA) acts as a modulator of left ventricular(LV) filling. Although there is considerable evidence to support the use of LA maximum and minimum volumes for disease prediction,theoretical considerations and a growing body of literature suggest to focus on the quantification of the three basic LA functions:(1) Reservoir function:collection of pulmonary venous return during LV systole;(2) Conduit function:passage of blood to the left ventricle during early LV diastole; and(3) Contractile booster pump function(augmentation of ventricular filling during late LV diastole. Tremendous advances in our ability to non-invasively characterize all three elements of atrial function include speckle tracking echocardiography(STE),and more recently cardiovascular magnetic resonance myocardial feature tracking(CMR-FT). Corresponding imaging biomarkers are increasingly recognized to have incremental roles in determining prognosis and risk stratification in cardiac dysfunction of different origins. The current editorial introduces the role of STE and CMR-FT for the functional assessment of LA deformation as determined by strain and strain rate imaging and provides an outlook of how this exciting field may develop in the future.

Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.

运用高时空分辨率MR k空间及时间敏感编码技术实时评估先天性心脏病病人左、右心室容积及功能

目的比较心电门控MR电影成像、标准实时MR成像及实时k空间-时间敏感编码成像3种技术评估先天性心脏病病人心室容积的大小。

Atrial fibrillation in diabetes: A cause for concern?

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and is associated with significant morbidity and mortality. It is becoming increasingly evident diabetes is a significant risk factor for the development of AF. The reason for this link is not clearly understood, however it is clear that other co-morbid diseases associated with diabetes such as hypertension and obesity may be implicated or there may be direct arrthymogenic affects of glucose dysregulation on the myocardium. The development of AF in patients with diabetes may be an ominous sign given the increased risk of death from cardiovascular disease and we propose this is an under researched area where treatments may bring benefits over and above those patients without diabetes in terms of morbidity or death from cardiovascular disease.

Large animal models of cardiac ischemia-reperfusion injury:Where are we now?

Large animal models of cardiac ischemia-reperfusion are critical for evaluation of the efficacy of cardioprotective interventions prior to clinical translation.Nonetheless,current cardioprotective strategies/interventions formulated in preclinical cardiovascular research are often limited to small animal models,which are not transferable or reproducible in large animal models due to different factors such as:(i)complex and varied features of human ischemic cardiac disease(ICD),which are challenging to mimic in animal models,(ii)significant differences in surgical techniques applied,and(iii)differences in cardiovascular anatomy and physiology between small versus large animals.This article highlights the advantages and disadvantages of different large animal models of preclinical cardiac ischemic reperfusion injury(IRI),as well as the different methods used to induce and assess IRI,and the obstacles faced in using large animals for translational research in the settings of cardiac IR.

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

Three-year outcomes of patients with non-valvular atrial fibrillation: the COOL-AF registry

BACKGROUND Clinical outcomes of patients with non-valvular atrial fibrillation(AF)in Asian populations may be different from non-Asians.In this study,we aimed to determine the incidence of ischemic stroke/systemic embolism(SSE),major bleeding,and death,and the predictors for clinical outcomes in a contemporary Asian cohort of newly diagnosed AF patients.METHODS This is a prospective multicenter nationwide registry of patients with AF from 27 hospitals in Thailand.Baseline data and follow-up data were collected every 6 months until 3 years.Data collections included demographic,medical history,laboratory,and medication details.Clinical outcomes were SSE,major bleeding,and all-cause mortality.Incidence rates for each clinical outcome were calculated and presented as rate per 100 person-years.Univariate and multivariate analysis was performed to determine the independent predictors for clinical outcomes.RESULTS There was a total of 3405 patients:mean age was 67.8±11.3 years,1981(58.2%)were male.During 30.8±9.7 months follow-up,there was a total of 132 SSE(3.9%),191 major bleeding(5.6%),and 357 all-cause deaths(10.5%).The incidence rates of SSE,major bleeding,and death were 1.56(1.30-1.84),2.26(1.96-2.61),and 4.17(3.33-4.25),per 100 person-years respectively.Independent predictors for clinical outcomes were age,type of AF,and the presence of comorbid conditions.CONCLUSION The incidence rate of SSE,major bleeding,and death remains high reflecting the unmet needs in AF management。

Age-dependent impact of the SYNTAX-score on longer-term mortality after percutaneous coronary intervention in an all-comer population

在有 TAXUS 和心脏的外科(句法) 的经皮的冠的干预之间的 BackgroundThe 协同作用分数在有复杂冠的动脉疾病的病人是为风险层化和 revascularization 策略选择的一个验证工具。学习是分析它的年龄相关的预示的 value.MethodsSYNTAX 分数的这的目的在经历经皮的冠的干预(一种总线标准) 的 1331 个所有来者病人被计算：463 个病人 75 年和 868 个病人 < 75 年。兴趣的结果是在一个和二 years.ResultsA 点的所有原因死亡为死亡的年龄和句法分数的重要相互作用被观察在二年(P 相互作用 = 0.019 ) 然而并非在一个年后续(P 相互作用 = 0.594 ) 。在 multivariable 分析，句法分数独立地在两个年龄组预言了 1 年的死亡(< 75 年，危险比率(HR ) ：1.43， 95% 信心间隔(CI ) ：1.03-2.00， P = 0.034；并且 75 年， HR：1.37， 95% CI：1.01-1.85， P = 0.042 ) ，但是在更年轻的病人之中的仅仅二年的死亡(< 75 年， HR：1.33， 95% CI：1.01-1.76， P = 0.041；并且 75 年， HR：1.11， 95% CI：0.87-1.41， P = 0.394 ) 。句法分数 tertiles 是有用的成层在两个的 1 年的死亡，病人 < 75 年(句法分数 < 9， 3.8% ；9-20， 5.3% ；20， 10.3% ；P = 0.004 ) 并且 75 年(句法分数 < 11， 5.7% ；11-22.5， 16.1% ；22.5， 18.7% ；P = 0.003 ) ，但是仅仅在病人之中的二年的死亡 < 75 年(句法分数 < 9， 6.5% ；9-20， 7.6% ；20， 15% ；P < 0.001 ) 并且不在 75 个岁病人之中(句法分数 < 11， 19.4% ；11-22.5， 26.3% ；22.5， 27.9% ；P = 0.138 ).ConclusionsAge 在一种总线标准以后在长术语的死亡上修改句法分数的影响。在病人之中 < 75 年，句法分数独立地在一种总线标准以后在一个和二年点预言死亡的风险，当时在病人之中它的预兆的角色在一种总线标准以后被限制到第一年的 75 年。进一步的研究被需要为在老病人之中选择最适当的 revascularization 策略评估句法分数的价值。

国际糖尿病足工作组:糖尿病足溃疡周围动脉病变诊断、预后与管理指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

1999年以来,国际糖尿病足工作组(IWGDF)已经多次发表循证医学基础上的糖尿病足预防与管理指南。该指南是有关糖尿病足溃疡合并周围动脉病变(PAD)患者的诊断、预后和管理指南,更新了以前IWGDF指南的内容。高达50%的糖尿病足溃疡患者同时患有PAD,这种病变使得患者截肢和心血管病变的风险明显增加。这类患者的诊断、预后和治疗明显地不同于那些没有PAD的糖尿病患者,但仅有很少的关于这类患者的高质量的研究强调了这点。我们遵循GRADE方法来提出临床问题并以至少包括患者-干预-比较-结局(PICO)形式说明重要结局,进行了系统的医学科学文献评价,写出推荐意见及其合理性。这类推荐是建立在系统文献评价的循证医学基础上的,没有证据时则在权衡利弊和患者选择、便宜性和干预的费用等因素后,采用专家的观点。这里我们发布更新的2019年糖尿病足溃疡合并PAD患者的有关PAD诊断、预后和管理的指南,以及一些需要未来特别关注的研究课题。

降脂药理学有什么新进展?整合基础研究和临床研究以改善患者治疗结果

自20世纪90年代以来,使用他汀类药物(以下简称他汀)一直是降脂治疗的主要方法。大量大规模随机对照试验表明,使用他汀疗法一年后,低密度脂蛋白(LDL)每年降低约1 mmol·L^(-1),主要心血管事件的风险降低约25%[1]。最近降脂领域的讨论集中在新的降脂药上,尤其是pro-protein convertase subtilisin/kexin type 9(PCSK9)抑制剂。

The Temporal Relation between Cardiomyopathy and LBBB and Response to Cardiac Resynchronization Therapy:Case Series and Literature Review

Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecting CRT candidates are needed.Methods:One hundred and seventeen consecutive heart failure patients were reviewed,24 of whom received CRT.Only two patients had a clear temporal relation between cardiomyopathy and LBBB.Results:Compared with the patient with“cardiomyopathy-induced LBBB,”the patient with“LBBB-induced cardiomyopathy”had higher left ventricular(LV)wall thickness,higher LV wall thickening rate,higher peak circumferential strain,and longer peak circumferential strain delay.The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue tracking.During follow-up,the patient with LBBB-induced cardiomyopathy had a good response to CRT(LV ejection fraction 23 before CRT vs.30%at 6 months vs.29 at 12 months vs.32%at 18 months;LV end-diastolic diameter 77 mm before CRT vs.66 mm at 6 months vs.62 mm at 12 months vs.63 mm at 18 months),and the other patient had no response to CRT(LV ejection fraction 29 before CRT vs.29%at 6 months vs.26 at 12 months vs.22%at 24 months;LV end-diastolic diameter 85 mm before CRT vs.88 mm at 6 months vs.85 mm at 12 months vs.84 mm at 24 months).Conclusion:The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response.Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT.Larger prospective clinical trials are needed to study the prevalence of,time course of,and risk factors for LBBB-induced cardiomyopathy.

CD36 expression and lipid metabolism following an oral glucose challenge in South Asians

AIM:To investigate lipid metabolism and the relationship with monocyte expression of the fatty acid translocase CD36 in South Asians.METHODS:An observational study of South Asians whom as an ethnic group have-a higher risk of developing diabetes.The susceptibility to diabetes is coupled with an earlier and more rapid progression of micro-,and macro-vascular complications.Twentynine healthy South Asian participants [mean age 34.6(8.9) years,76.2% male,mean body-mass index 25.0(5.2) kg/m2] were recruited from an urban residential area of central Birmingham(United Kingdom).The main outcomes measured were post prandial(30 min) and post absorptive(120 min) changes from fasting(0 min) in circulating lipoproteins,lipds and hormones,andmonocyte expression of CD36 post injection of a 75 g oral glucose challenge.The inducements of variations of monocyte CD36 expression were analysed.RESULTS:Our results showed evident changes in monocyte CD36 expression following the glucose challenge(P < 0.001).Non-esterified fatty acids(NEFA) levels decreased progressively during the challenge(P < 0.001),in contrast to increased cholesterol(but not triglyceride) concentrations within very low density lipoprotein(VLDL) and low density lipoprotein subfractions(P < 0.01).Levels of,glucose,serum triglycerides and high density lipoprotein cholesterol remained largely unchanged.Variations of monocyte CD36 were negatively(r =-0.47,P = 0.04) associated to fat from the diet and positively to carbohydrate from the diet(r = 0.65,P < 0.001).CONCLUSION:These data suggest that the initiation of VLDL genesis follows the consumption of glucose within this population,inferring that the sequestration of NEFA from these particles happens due to the increased availability of CD36 receptors.While these are preliminary results,it would appear that lifestyle exposures have a role in moderating the expression of CD36.

Innate immune receptors in heart failure: Side effect or potential therapeutic target?

Heart failure(HF) is a leading cause of mortality and morbidity in western countries and occasions major expenses for public health systems. Although optimal medical treatment is widely available according to current guidelines, the prognosis of patients with HF is still poor. Despite the etiology of the disease, increased systemic or cardiac activation of the innate immune system is well documented in several types of HF. In some cases there is evidence of an association between innate immune activation and clinical outcome of patients with this disease. However, the few large trials conducted with the use of anti-inflammatory medication in HF have not revealed its benefits. Thus, greater understanding of the relationship between alteration in the immune system and development and progression of HF is urgently necessary: prior to designing therapeutic interventions that target pathological inflammatory processes in preventing harmful cardiac effects of immune modulatory therapy. In this regard, relatively recently discovered receptors of the innate immune system, i.e., namely toll-like receptors(TLRs) and nodlike receptors(NLRs)-are the focus of intense cardiovascular research. These receptors are main up-stream regulators of cytokine activation. This review will focus on current knowledge of the role of TLRs and NLRs, as well as on downstream cytokine activation, and will discuss potential therapeutic implications.

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two-phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualitative thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was considered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people under-report morbidity related to smoking and chronic obstructive pulmonary disease;other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes.