Scott M. Grundy's research while affiliated with University of Texas Southwestern Medical Center and other places

Publications (863)

Article
Guidelines support lowering cholesterol to decrease atherosclerotic cardiovascular disease (ASCVD) risk across the entire lifespan with intensive lifestyle intervention, as well as statin and non-statin pharmacotherapy for those at highest risk. Modest improvements in the initiation, use, and adherence to statin therapy in patients with ASCVD have...
Article
Current cholesterol guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) base statin treatment decisions on multiple risk factor algorithms (e.g., Pooled Cohort Equations [PCEs]). By available PCEs, most older middle-aged men are statin eligible. But several studies cast doubt on predictive accuracy of available PCEs...
Article
This Editorial compares the US Preventive Services Task Force (USPSTF) recommendations with the American Heart Association/American College of Cardiology (AHA/ACC)/multisociety guidelines on statin usage in primary prevention.
Article
Statins reduce atherosclerotic cardiovascular disease (ASCVD) similarly in women and men. Women develop coronary atherosclerosis more slowly than men. By late middle age, most men have enough atherosclerosis to warrant statin therapy; but in this age range, only about one fourth of women are statin eligible, as implied by coronary artery calcium (C...
Article
There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature...
Article
Full-text available
Background Pooled cohort equations (PCEs) estimate 10-year risk for atherosclerotic cardiovascular disease (ASCVD) in US adults. One use is to guide statin eligibility. However, PCEs risk estimate is inaccurate in some US subpopulations. Objective Recent cholesterol guidelines proposed addition of risk enhancing factors to improve risk assessment...
Article
Over the long-term, at least half of patients started on statins will discontinue them. Statin noncompliance can be defined as discontinuing therapy for whatever reason. This results from four causes: dysfunction of the health care system; fear of side effects (nocebo effect); disorders of the musculoskeletal system or other organs misconstrued as...
Article
Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary preventio...
Article
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Ass...
Article
Full-text available
In 2018, cardiovascular society cholesterol guidelines recommended use of coronary artery calcium to guide statin therapy in patients 40-79 years who are at intermediate risk by multiple risk factor equations, i.e., estimated 10-year risk for atherosclerotic disease 7.5-19.9%, but in whom statin benefit is uncertain. Many such patients have no coro...
Article
Full-text available
Background Statins effectively reduce risk for atherosclerotic cardiovascular disease (ASCVD) when 10-year risk is ≥ 7.5%. In many patients at intermediate risk (7.5-<20% risk), there is uncertainty about reliability of risk assessment by current pooled cohort equations (PCE). A decision to initiate statin therapy is favored by several risk enhanci...
Chapter
In this chapter, we discuss the 2018 AHA/ACC/Multisociety (American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Physician Assistants, Association of Black Cardiologists, American College of Preventive Medicine, American Diabetes Association, American Geriatrics Society, American Pharmacists Association, American...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Article
Full-text available
Background Chronic kidney disease (CKD) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). American cardiovascular societies consider CKD a risk-enhancing factor that supports statin therapy in intermediate-risk patients aged 40–75 years. In contrast, European cardiovascular societies recommend statins for all middle-aged adults w...
Article
The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines recently published its 2018 recommendations on management of LDL cholesterol (LDL-C) in people with diabetes. For primary prevention, moderate-intensity statin therapy is recommended for those aged 40-75 years, with a preference for high-intensi...
Article
Full-text available
Background Non-HDL C includes atherogenic cholesterol and low-density lipoproteins (LDL) and triglyceride-rich lipoproteins. Patients with diabetes frequently have elevations in non-HDL C. Objective This study examines temporal trends in levels of non-HDL C in free-living subjects with diabetes but a negative history of atherosclerotic cardiovascu...
Chapter
The metabolic syndrome is a multiple risk factor complex for atherosclerotic cardiovascular disease (ASCVD). These risk factors consist of atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a pro-inflammatory state. The presence of the metabolic syndrome doubles the risk for ASCVD and causes a fiv...
Article
The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program's Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understand...
Article
To the Editor In his Viewpoint,¹ Dr Skolnik discussed the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the management of blood cholesterol² and its implications for older adults. We would like to highlight relevant features of the guidelines that merit greater recognition.
Article
Description: In November 2018, the American Heart Association and American College of Cardiology (AHA/ACC) released a new clinical practice guideline on cholesterol management. It was accompanied by a risk assessment report on primary prevention of atherosclerotic cardiovascular disease (ASCVD). Methods: A panel of experts free of recent and rel...
Article
Full-text available
Background Low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) are targets for prevention of atherosclerotic cardiovascular disease (ASCVD). The American Heart Association and American College of Cardiology recently modified recommendations for clinical management of cholesterol in secondary and prim...
Article
Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death in the United States.¹ Most deaths from ASCVD occur in patients with preexisting ASCVD. Secondary prevention trials in patients with established ASCVD demonstrate that low-density lipoprotein cholesterol (LDL-C)–lowering therapy with statins reduces recurrent cardiovas...
Article
Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death in the United States.¹ Elevated low-density lipoprotein cholesterol (LDL-C) level is a major risk factor for ASCVD. Randomized clinical trials of patients without ASCVD demonstrate that lowering LDL-C levels reduces risk for future cardiovascular events. Statins are pr...
Article
These 4 hypothetical cases highlight some of the new features in the 2018 American Heart Association/American College of Cardiology multisociety cholesterol management guidelines. Topics include management issues in a secondary prevention patient judged to be at very high risk of another event, a patient with familial hypercholesterolemia with a lo...
Article
Background: The associations of low-density lipoprotein cholesterol (LDL-C) with cardiovascular disease (CVD) and coronary heart disease mortality in an exclusively low estimated 10-year risk group are not well delineated. We sought to determine the long-term associations of various LDL-C and non-high-density lipoprotein cholesterol (HDL-C) thresh...
Article
Background: Excess visceral adipose tissue (VAT) is associated with an increased risk of prediabetes and type 2 diabetes (T2D) independent of body mass index (BMI). Whether expansion of VAT or other fat depots is associated with diabetes risk independent of weight gain is not fully known. Methods: Among participants without prevalent diabetes or ca...
Article
Full-text available
The metabolic syndrome is a constellation of risk factors including dyslipidemia, dysglycemia, hypertension, a pro‐inflammatory state, and a prothrombotic state. All of these factors are accentuated by obesity. However, obesity can be defined by body mass index (BMI), percent body fat, or by body fat distribution. The latter consists of upper body...
Article
Full-text available
Context Polycystic ovarian syndrome (PCOS) is often associated with obesity and diabetes. Objective This study measured body fat distribution and metabolic risk factors in women with features of PCOS. Design Cross-sectional, multi-ethnic, study of cardiovascular risks. Setting General community Study Participants 145 PCOS and 344 non-PCOS women...
Research
Full-text available
2004 NHLBI Workshop/Working Group on the Future Clinical Research Directions On Omega-3 Fatty Acids and Cardiovascular Disease
Article
Objective: To examine the association between specific adipose tissue depots and the risk of incident cancer in the Dallas Heart Study. Patients and methods: Individuals without prevalent cancer in the Dallas Heart Study underwent quantification of adipose depots: visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue, and liver fa...
Article
Full-text available
An ongoing dispute in the nutrition field is whether dietary cholesterol contributes significantly to elevated serum cholesterol and to atherosclerotic disease. Carefully controlled metabolic studies have shown that high-cholesterol intakes cause moderate increases in serum cholesterol levels. It is been difficult to verify this in population studi...
Article
Full-text available
Importance: The comparative clinical benefit of nonstatin therapies that reduce low-density lipoprotein cholesterol (LDL-C) remains uncertain. Objective: To evaluate the association between lowering LDL-C and relative cardiovascular risk reduction across different statin and nonstatin therapies. Data sources and study selection: The MEDLINE an...
Article
Full-text available
Background: Both triglyceride-to-high density lipoprotein cholesterol (TG/HDL-C) and cardiorespiratory fitness (CRF) impart risk for all-cause morbidity and mortality independently of conventional risk factors. Objective: To determine prevalence and/or incidence of high TG/HDL-C ratio in men with low CRF. Methods: Clinical characteristics and...
Article
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Background/objectives: Visceral adipose tissue (VAT) mass, a risk factor for cardiometabolic complications of obesity, is usually measured by magnetic resonance imaging (MRI) but this method is not practical in a clinical setting. In contrast, measurement of VAT by dual-x-ray absorptiometry (DXA) appears to circumvent the limitations of MRI. In th...
Article
The metabolic syndrome is a constellation of metabolic risk factors including atherogenic dyslipidemia (elevated serum triglycerides, reduced high-density lipoprotein (HDL) cholesterol), elevated blood pressure, dysglycemia (insulin resistance and elevated serum glucose), a pro-inflammatory state, and a prothrombotic state. Most persons with metabo...
Article
Scavenger receptor B-1 (SR-B1) facilitates reverse cholesterol transport by transferring cholesterol esters of high-density lipoproteins (HDLs) into the liver. Zanoni et al. (2016) report that a genetic deficiency of normal SR-B1 appears to predispose subjects to coronary heart disease in spite of raising serum HDL cholesterol levels.
Article
Statins remain the first-line therapy for dyslipidaemia. In 2015, however, effectiveness in reducing serum cholesterol levels and decreasing rates of cardiovascular disease in combination with statins has been demonstrated for two new classes of drugs: cholesterol-absorption inhibitors and PCSK9 inhibitors. The latter rival statins in their capacit...
Article
Full-text available
Background: Moderate hypertriglyceridemia is frequently associated with central obesity, insulin resistance, and atherogenic dyslipidemia. We showed previously that moderately obese men with hypertriglyceridemia have reduced fatty acid oxidation postabsorptively and postprandially. In the present study, we examined the oxidation of fatty acids in...
Article
Background: Understanding the genetic basis of airflow obstruction and smoking behaviour is key to determining the pathophysiology of chronic obstructive pulmonary disease (COPD). We used UK Biobank data to study the genetic causes of smoking behaviour and lung health. Methods: We sampled individuals of European ancestry from UK Biobank, from the m...
Article
The metabolic syndrome is a multiplex risk factor for atherosclerotic cardiovascular disease and type 2 diabetes. It is composed of atherogenic dyslipidemia, elevated blood pressure, insulin resistance and elevated glucose, a pro-thrombotic state, and a pro-inflammatory state. Excess energy intake and concomitant obesity are the major drivers of th...
Article
Full-text available
An Expert Panel convened by the National Lipid Association previously developed a consensus set of recommendations for the patient-centered management of dyslipidemia in clinical medicine (part 1). These were guided by the principle that reducing elevated levels of atherogenic cholesterol (non-high-density lipoprotein cholesterol and low-density li...
Article
The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The...
Article
Full-text available
Obesity is strongly associated with metabolic syndrome. Recent research suggests that excess adipose tissue plays an important role in development of the syndrome. On the other hand, persons with a deficiency of adipose tissue (e.g. lipodystrophy) also manifest the metabolic syndrome. In some animal models, expansion of adipose tissue pools mitigat...
Article
Emerging evidence suggests that significant heterogeneity exists in the cardiometabolic risk associated with excess body fat in obese individuals (1). We investigated the associations of novel imaging markers of adiposity, including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) by magnetic resonance imaging, lower bo...
Chapter
Since the 1980s, cholesterol guidelines for Americans have been sponsored by The National Heart, Lung, and Blood Institute of the National Institutes of Health. These guidelines were produced by the National Cholesterol Education Program. From this program, an Adult Treatment Panel (ATP) has organized the major sets of guidelines. Three reports wer...
Article
A low level of cardiorespiratory fitness (CRF) is a strong and independent predictor of all-cause mortality in men; however it is unknown if a gradient of mortality risk exists within the lowest CRF category. 6251 apparently healthy men (mean age 48.7 ± 6.3 years) completed a comprehensive baseline clinical exam, including a maximal treadmill exerc...
Article
Full-text available
Unlabelled: Several plasma non-lipid biomarkers have been shown to predict major cardiovascular events (MCVEs) in population studies. Our objective was to investigate the relationship between lipid and non-lipid biomarkers levels achieved during statin therapy and the incidence of MCVEs in patients with stable coronary heart disease (CHD). We cond...
Article
Online address: http://www.molmed.org DISCLOSURE The authors declare that they have no competing interests as defined by Molecular Medicine, or other interests that might be perceived to influence the results and discussion reported in this paper.
Article
Recent guidelines for cholesterol management proposed by the American College of Cardiology (ACC) and American Heart Association (AHA) recommended statin therapy for most men in their 60s and most women in their 70s. If these guidelines are followed in the USA, most adults will eventually take statins. A companion article in this journal goes a ste...
Chapter
The link between elevated LDL-C levels and increased risk of coronary heart disease (CHD) events is well established. The primary hypothesis of Treating to New Targets (TNT) was that reducing LDL-C levels to well below 100 mg/dL (2.6 mmol/L) in stable CHD patients with modest LDL-C elevation could yield incremental clinical benefit. This hypothesis...
Chapter
In the Treating to New Targets (TNT) study, 10,001 patients with stable CHD and LDL-C levels <130 mg/dL (3.4 mmol/L) were randomized to double-blind therapy with either atorvastatin 10 or 80 mg/day and were followed for a median of 4.9 years. The primary endpoint was an occurrence of a first major cardiovascular event, defined as CHD death, nonfata...
Article
Full-text available
The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary...
Article
The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines recently issued the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. This new guideline endorses a paradigm shift in strategies for reducing atherosclerotic cardiovascular d...
Article
Background Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented. Objectives The aim of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), no...
Article
Statin therapy reduces the risk of myocardial infarction, stroke, and cardiovascular death by 25% to 30% in primary as well as secondary prevention patients. Thus, statins are the pharmacologic therapy of choice for the management of high blood cholesterol levels. Prompted by examination of clinical trial data suggesting a modest, but statistically...
Article
This article from the National Lipid Association Statin Intolerance Panel provides a framework for understanding statin intolerance and makes general recommendations for health professionals. For specific guidance on adverse events related to muscle, liver, cognition, and glucose metabolism, one should refer to the other reports of the Statin Safet...
Article
During the American Heart Association's Scientific Sessions in November 2014, this Editor had the opportunity to interview Dr. Scott Grundy regarding the new recommendations for guideline development that was issued by the International Atherosclerosis Society. (The full document is published in this issue of the journal). In developing this report...
Article
An international panel of the International Atherosclerosis Society has developed a new set of recommendations for the management of dyslipidemia. The panel identifies non high-density lipoprotein cholesterol as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins...