The Basis of Atherosclerotic Guidelines—Time for a Change?

Major advances have occurred within the last decade in the understanding of the pathogenesis of coronary artery disease. Not only are the underlying mechanisms now clearly defined, but effective medical therapies are available at low cost and minimal side effects. In spite of these advances, cardiovascular events are still the leading cause of death in the United States and the Western world. Analysis of the many factors involved in the delivery of appropriate cardiovascular care strongly suggests that the primary reason is the overly restrictive guidelines published by medical societies. This article proposes a much broader basis for constructing atherosclerosis clinical guidelines, namely the known pathophysiology of atherosclerosis. If pathophysiology forms the basis of atherosclerotic treatment recommendations, then a risk/benefit analysis can be used to determine appropriate preventive therapy for any specific individual. The result will be that many additional individuals will be eligible for preventive treatment of atherosclerosis, and the saving of many lives at minimal cost will result.

Evidence that Low Density Lipoprotein Is the Primary Cause of Atherosclerotic Cardiovascular Disease: A Bradford-Hill Approach

Cardiovascular disease is the leading cause of death in the Westernized world. The costs in productive lives lost to individuals, families, and society?are?staggering. The epidemiology, pathogenesis, and preventative?treatment?are all clearly described. Why then, has this epidemic not been eradicated? One reason is the uncertainty about the primary cause of atherosclerotic cardiovascular disease. Low density lipoprotein (LDL) is a circulating lipid particle that deposits cholesterol into the arterial wall?which?subsequently evolves into an atherosclerotic plaque and a life-threatening arterial thrombosis. The reason that LDL is not universally accepted as the cause of atherosclerosisis that there are no randomized controlled trials (RCT’s) providing this evidence. For ethical, financial, and scientific?reasons, an RCT of sufficient duration to prove or disprove this hypothesis?may never be initiated. We propose a?unique approach to support the critical role of LDL in the pathogenesis of cardiovascular disease. Employing criteria based on those proposed by Sir Austin Bradford Hill, we describe the large body of scientific evidence supporting LDL as the primary cause of atherosclerosis. Sir Austin Bradford Hill was a British epidemiologist/statistician who lived in the 20th?century. He acknowledged that the cause of a disease could not always be established by a randomized clinical trial. Therefore, he outlined nine criteria (now known as the Bradford-Hill criteria) that should be met if an etiological factor was likely the cause of a disease. The data in this manuscript are organized according to these nine criteria. These data strongly suggest that LDL is the primary cause of atherosclerotic cardiovascular disease and that sufficient LDL reduction (i.e., to mmol/L) will lead to atherosclerotic cardiovascular disease becoming a rare event.

The Development and Application of CISMOD 1.0, a New Computerized Tool for Designing Wildlife Rainwater Cisterns

This article reports on a case study of the research and development of a new tool to assist in the design of rainwater cisterns. A rainwater cistern is a way to improve wildlife habitat because it can be situated in locations that do not have natural water sources, such as streams or wells that can supply water for storage. However, the design and sizing of such a system can be challenging because a number of constantly varying factors must be considered, such as changing precipitation patterns, the evaporative losses from the cistern and animal water consumption. No standardized sizing methodology currently exists for designing wildlife rainwater cisterns. In this article we present a new method for assisting in optimally sizing a rainwater cistern. We discuss how we implemented the quantitative portion of this methodology into a new Excel? model called CISMOD, which we configured for general use by wildlife professionals. We describe the methodology for designing a rainwater cistern based on standard engineering techniques. We then present and discuss our experience in applying the model to design two rainwater cisterns in an area of the Jemez Mountains in northern New Mexico, USA. The CISMOD model and a user manual are available at no cost for wildlife professionals.