Potential neural embedding of parental social standing

Socioeconomic disadvantage during childhood and adolescence predicts poor mental and physical health and premature death by major medical diseases in adulthood. However, the neural pathways through which socioeconomic factors may exert a developmental influence on health and longevity remain largely unknown. This fMRI study provides novel evidence of a unique relationship between the perception that one's parents had a relatively low social standing--a putative indicator of early socioeconomic disadvantage--and greater amygdala reactivity to threatening facial expressions. This relationship was not explained by several possible confounders, including sex, ethnicity, dispositional emotionality, symptoms of depression and anxiety, parental education and participants' perceptions of their own social standing. The amygdala expresses marked developmental plasticity and plays instrumental roles in processing emotional information, regulating emotion-related behaviors and orchestrating biobehavioral stress responses throughout life. Thus, these findings may provide insight into the neurodevelopmental pathways impacting socioeconomic disparities in health.     

More medications, fewer pills: combination medications for the treatment of hypertension

Achieving blood pressure targets in hypertension can be challenging. Often, patients require multiple medications to reach these targets. The Canadian Hypertension Education Program has updated its past recommendations to reflect current knowledge regarding effective antihypertensive combinations. Evidence for the use of specific drug combinations in achieving blood pressure targets has been reviewed, and the inventory of effective drug combinations has been expanded. From a clinical perspective, fixed-dose antihypertensive combinations offer certain advantages in terms of efficacy, adherence, cost, convenience, patient-perceived 'wellness' and side effects. Consequently, in the future, fixed-dose combination formulations are likely to become increasingly used in the treatment of cardiovascular disease.     

Improving outcomes in diabetes and chronic kidney disease: the basis for Canadian guidelines

The prevalence of diabetes is on the rise in Canada, and there has been a corresponding increase in the rate of micro- and macrovascular complications. Among the worst of these is chronic kidney disease (CKD). It may be diagnosed either through the detection of persistent albuminuria or an estimated glomerular filtration rate that is persistently less than 60 mL/min/1.73 m2. Patients with diabetes and CKD have a lower quality of life and higher health care costs, and face the prospect of end-stage renal disease requiring dialysis. More importantly, this group has an extremely elevated cardiovascular risk and correspondingly reduced survival. Research over several decades has led to two important conclusions. First, progressive worsening of kidney disease is not inevitable in people with diabetes; it can be slowed or even stopped. Second, the elevated cardiovascular risk in this population can be significantly reduced through an aggressive approach to cardiovascular risk factor reduction. These conclusions have prompted Canadian guideline groups, such as the Canadian Diabetes Association and the Canadian Hypertension Education Program, to release clinical practice guidelines that address the management of people with diabetes and CKD. In the present article, the studies that have influenced these Canadian guidelines are examined, and areas in which further research is still required are identified.     

Symptoms, depression, and quality of life in patients with heart failure

BackgroundLittle is known about symptoms and their burden in outpatients with chronic heart failure. Diverse symptoms may be associated with poor heart failure-related quality of life, and depression may be related to increased symptoms.Methods and ResultsThe number of symptoms and symptom distress (physical symptoms on the Memorial Symptom Assessment Scale-Short Form), depression (Geriatric Depression Scale-Short Form), and heart failure-related quality of life (Kansas City Cardiomyopathy Questionnaire) were measured cross-sectionally in 60 patients with heart failure from two outpatient cardiology clinics. Patients experienced a mean of nine symptoms in the previous week. More than half reported shortness of breath, lack of energy, pain, feeling drowsy, or dry mouth. In unadjusted analyses, more severe depression was associated with a greater number of symptoms (r = 0.51, P < .0001) and greater overall symptom distress (r = 0.58, P < .0001). For each additional depression symptom, the number of symptoms reported increased by 0.6 after adjustment for age, race, and N-terminal pro-brain natriuretic peptide (P = .01). The number of symptoms accounted for 32% of the variance in quality of life (P < .0001).ConclusionsPatients with heart failure report a large number of distressing symptoms. Depression in patients with heart failure is associated with a greater number of symptoms, which in turn is associated with a decrease in heart failure-related quality of life. Treatment of depression and the diverse symptoms reported by patients with heart failure might significantly improve quality of life.