Day 2 :
University of Texas McGovern Medical School, USA
Time : 09:00-09:35
John P Breinholt has completed his MD at the University of Utah School of Medicine. He completed his Pediatrics Residency, Pediatric Cardiology Fellowship andrnadvanced training in Pediatric Interventional Cardiology at Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas. He is the Division Director of Pediatric Cardiology at the University of Texas Health Science Center at Houston and the Chief of Pediatric Cardiology at Children’s Memorial Hermann Hospital.rnHe is also the Pediatric Cardiology fellowship Director. He has published more than 25 papers in reputed journals and has been serving as an Editorial BoardrnMember of repute.
The field of pediatric interventional cardiology has made significant strides over the past 3 decades. As increasing procedure s are developed, likewise, the ability to apply those procedures and technologies to smaller patients has increased of the years. Neonates have principally benefited from the development of smaller profile catheters and balloons, enabling important interventions to be performed. However, the ability to implant permanent devices in small children is limited by somatic growth and the alternations to the surrounding anatomy that occurs,thus preventing their use until patients reach larger sizes where the ability to implant appropriate devices can occur. This applies largely to the area of endovascular stents. Diseases such as pulmonary artery stenosis and coarctation of the aorta represent important diseases whose most definitive therapy involves the placement of large stents that can be either principally, or at later procedures, dilated to adult vessel sizes. These devices are not reasonable alternative for small children given their length and width that make the delivery systems prohibitive. The advent of biodegradable materials provides an opportunity to design devices that can be placed in these small children without the concern of later somatic growth. As the child grows, the device will dissolve,and not create an iatrogenic stenosis at a later date. We discuss the present state of stent technology and potential applications of this technology in small congenital heart disease patients.
- Sessions: Cardiovascular Industries Market Research | Cardiovascular Case Studies | Clinical Trials in Cardiology
Université Paris Diderot, France
Enrique GarcĂ¨s Hospital, Ecuador
Title: Gender differences in patients who suffered an acute myocardial infarction with ST segment elevation: Women are treated differently?
Time : 09:35-10:05
Paulina Cisneros Clavijo completed her first speciality in Cardiology in Havana Uuniversity in 2007. After she completed a second speciality as Interventional Cardiology and Hemodynamics in Buenos Aires University. She did some courses in Yale Hospital and Italian Hospital from Buenos Aires. She presented and published some papers in reputed journals and in some congress like TCT, PCR, SOLACI among others.
Introduction: The early myocardial reperfusion obtained by primary angioplasty can reduce morbidity and mortality from acute myocardial infarction. The delay in the decision-making plays a fundamental role in the evolution of ischemia. Objective: Determine the differences of times of miocardial infarction resolute differences in technique and/or adjuvants as well as the evolution in women who suffered an acute myocardial infarction with ST segment elevation less than 24 hours of evolution. Material & Methods: 79 consecutive patients who suffered an acute myocardial infarction with ST segment elevation (STEMI) in <24 hrs admitted in our institution since April 2012 to June 2013 were selected and prospectively analyzed. All patients underwent coronary angioplasty with premedication: 300 mg aspirin, clopidogrel and heparin 70UI 600 mg/kg. It was the decision of the operator to use thrombus aspiration catheter and/or glycoprotein inhibitors IIbIIIa. The monitoring by medical history were embodied if the patients had reinfarction, major bleeding, minor bleeding, pain until arrival to hospital from time of onset, need for ventilatory assistance and use of balloon counterpulsation and hospital death. The above parameters were performed in the first 30 days. Results: 30 women from 79 infarctions were analyzed. The characteristics observed were gender (women vs. men) with age 66 +/- 15 vs. 66 +/- 25, No differences with previous revascularization: 3/30 vs. 3/49, peripheral vascular disease: 13/30 (43%) vs. 23/49 (46%). There was no significant difference in the presence of chronic renal failure. They were presented in between 8:00-18:00 (on-hours, women vs. men): 13 (43%) vs. 21 (42%)% and 18:00-08:00 (off-hours, women vs. men): 17 (56%) vs. 28 (57%). The delay in opening the artery (center-to-balloon time) was 62.3 ± 40 min with no significant differences between genders. CPK peak value of 2093 IU / L vs. 2032UI / L (women vs. men) was observed . Major bleeding: (0% vs. 0%) was observed; thrombosis: 0 vs. 0; need for mechanical ventilation: 2 vs. 5; use of aortic balloon counterpulsation pump 2 vs. 5; deaths in 3 patients before discharge. At the time of hospitalization despite no significant difference, there was a tendency of much time with women (8 vs. 7 days). Conclusions: The differences observed were mainly women were less smokers, they had less previous infarctions and less diabetes; but they had higher obesity rate that correlates with the frequency of dyslipidemia and had more hypertension. They had a higher percentage of infarctions corresponding with the territory of anterior descending artery and the presentation was at times off-hours. Women had more minor bleeding. It is mandatory to extend to large-scale studies to extrapolate the data in this small population analyzed. It is important to conclude that there is a significant delay in the onset of pain and arrival at the hospital that the KK producing them forward to a Class II or directly to a Class IV.
UniversitĂ© Paris Diderot, France
Time : 10:05-10:35
Jean-Baptiste Fraison has completed his Doctoral thesis in Internal Medicine in the year 2013 from Montpellier University School of Medicine. He is currently an
Assistant Professor in Internal Medicine department of Dr. Alfred Mahr (Hôpital St Louis, Université Paris Diderot, France). His research interests include vasculitis especially Behcet disease and Kawasaki disease.
Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France. We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature in 27 French centers. We included 44 cases of AKD, with mean (SD) age 31 (12) years (range 18–68) and sex ratio (M/F) 1:2; 33 cases met the American Heart Association criteria; 9 were incomplete and 2 were a typical AKD. The median time for diagnosis was 15 days (interquartile range 9–21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Biological findings revealed the elevated levels of acute-phase reactants (100%), hepatic cytolysis (64%) and elevated bilirubin level (23%). Overall, 32% of cases showed large-vessel vasculitis: Coronary vasculitis (25%), coronary aneurysm (16%) and peripheral vasculitis (4.5%). Treatment was mostly intravenous immunoglobulins (73%) and aspirin (81%). Out of all the cases, four cases showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (interquartile 2-17, range 1–117), persistent aneurysm was noted in 7% of cases. No deaths were reported hence, damage was significantly lower with early treatment than late or no treatment (p=0.02).
University of Texas McGovern Medical School, USA
Title: The patent ductus arteriosus of premature neonates should be closed via transcatheter techniques instead of surgical ligation
Time : 10:35-11:05
John P Breinholt has completed his MD at the University of Utah School of Medicine. He completed his Pediatrics Residency, Pediatric Cardiology Fellowship and advanced training in Pediatric Interventional Cardiology at Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas. He is the Division Director of Pediatric Cardiology at the University of Texas Health Science Center at Houston and the Chief of Pediatric Cardiology at Children’s Memorial Hermann Hospital. He is also the Pediatric Cardiology fellowship Director. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of repute.
The patent ductus arteriosus (PDA) of premature neonates continues to be a significant clinical problem contributing importantly to both morbidity and mortality. Surgical ligation and medical therapy both have their drawbacks. Medical therapy has a high failure rate and is associated with the renal dysfunction and gastrointestinal morbidities. Surgical ligation has a high success rate, but has been associated with pneumothorax, phrenic nerve palsy and vocal cord paralysis, and scoliosis. While transcatheter PDA closure has been performed for nearly 40 years, it has largely been reserved for children >5 kg. We have focused on the safety and efficacy of PDA device closure in premature neonates <3 kg. The hospital records and catheterization reports of premature neonates were reviewed with attention to procedural details, complications, and short term outcomes. We recorded the results of neonates
who received one of two commercially available devices for PDA closure, with a focus on a newly available microvascular plug that enables delivery via a microcatheter. The device is delivered with fluoroscopy and echocardiographic guidance. Complete closure was achieved in all patients. All patients survived the procedure and are currently living. There have been no instances left pulmonary artery obstruction or coarctation of the aorta. This preliminary study demonstrates that transcatheter PDA closure can be successfully performed in preterm neonates using currently available technology with a high success rate and a low incidence of complications. We also describe a novel transvenous approach using a combination of echocardiography and fluoroscopy to avoid arterial access in this fragile patient population.
University Hospital of South Manchester, UK
Time : 11:50-12:20
Ana-Catarina Pinho-Gomes has completed her MSc in Medicine as well as in Cardiovascular Pathophysiology from the University of Porto, Portugal. She has been training in UK since then and is currently a Cardiothoracic Surgery trainee in Manchester. She has already won over 25 academic prizes and published 8 papers in reputed journals. She is member of the leading committees like Association of Surgeons in Training and the Cardiothoracic Trainees Research Collaborative. Besides translational and clinical research in Cardiovascular Medicine, she is keen on teaching and she is doing a MSc in Medical Education at the University of Liverpool.
Background: Above Knee Amputation (AKA) is a last-resort operation with high post-operative morbidity and mortality. The aim of this study was to identify preoperative risk factors for mortality in patients undergoing AKA for lower limb ischaemia.
Methods: Medical records of all the patients who underwent AKA for limb-threatening ischaemia between the 1st September 2014 and the 31st December 2015 were retrospectively reviewed. Patients were followed-up until 31st January 2016.
Results: A total of 65 patients (33 male; median age 75 [IQR 65-82] years) were included. 54 were treated for critical limb ischaemia, and the remainder for acute ischaemia. Hypertension, ischaemia heart disease, chronic obstructive pulmonary disease and type 2 diabetes mellitus were common (prevalence of 71%, 37%, 40% and 47%, respectively). Median length of stay was 27 [IQR 17-56] days and the proportion of patients requiring long-term residential care significantly increased from admission to discharge (p=0.005).
In-hospital mortality was 17% (11 patients), in all cases due to septic complications, most commonly from respiratory and wound sources. 90-day mortality was 30% (19 patients). Heart failure (OR8.9 95%CI 2.1-36.8; p=0.003) and eGFR<30 (OR11.9 95%CI 1.4-101.6; p=0.023) were independent predictors for 90-day mortality. At a median follow-up of 7.5 [IQR 2-16] months, all-cause mortality was 38% (25 patients) and median survival was 60 [IQR 29-102] days.
Conclusions: AKA performed for limb-threatening ischaemia is associated with high morbidity and mortality and hence, it imposes a major health-care burden. Patients with renal impairment and heart failure on admission have a significantly increased mortality risk.
Abdul Aziz, MD MRCP associate specialist in preventive cardiology. He is working at nobles hospital. His special interest in preventing af related strokes. He is involved in making effective strategies to improve the detection and effective anticoagulation of af in the community and secondary care.
Atrial fibrilation is the most common sustained arrhythmia affectng apropximately 2 percent of population in devellopng countries. It is the most common preventable cause of strokes. Atrial fibrilation accounts directly for 15 percent of strokes and is contributary factor in 20 percent of strokes.
Strokes related to AF caries high mortality and morbidity, 1 in 4 patients will die in the first 30 days and 50 percent will die with in the first year. Stroke related to AF are more debiliating and has higher chance of recurence.
The estimated cost for a new stroke with AF is £14000/year comared to stroke with no AF at £9000. Aging population is on the rise so is AF and AF related strokes. Despite the availability of modern tooles approximatley half of patients are undetected, and only 50% of patient diagnosed with AF recieving optimal anticoagulation. Despite the availability of NOACs there seems to be no significant improvement in prevent devastating strokes in AF. Review of performance in the UK from SSNAP audit data and GARFIELD-AF inthe UK, use of NOACs
- Young Research Forum
Magdy Abdel Hamid
Cairo University, Egypt
Castle Hill Hospital, UK
Time : 14:45-15:10
Azar Hussain has completed his MBBS from Pakistan and completed his MRCS from Royal College of Surgeons of Edinburgh. He completed his MSc in Translational Research in cardiovascular medicine from university of Bristol. At present, he is pursuing his MD on ‘Effect of oxygen on small human pulmonary artery’ from Hull York Medical School. He is also pursuing a Diploma in Post-graduate research training and an MSc in healthcare improvement leadership. He published 5 papers in reputed journals and delivered talks on both national and international cardiothoracic forum.
Background: Different models are used to explore the underlying cellular and molecular mechanism of lung disease especially pulmonary vascular disease but most of the experiments were performed on animal models with little evidence available from humans.
Objective: The aim of this study is to provide a baseline optimal resting tension (ORT) value for performing experiments on human pulmonary artery rings and strips.
Methods: After REC approval, tissue samples were collected from lung surgery patients. Total 20 PA rings of internal diameter 2-4 mm and 2 mm long were prepared and mounted under physiological conditions in organ bath system and myograph. After equilibration at 1g basal tension, 40mM KCl induced active tension (AT) recorded. Samples washed for 30 minutes and repeated twice at 1g to confirm reproducibility. Further experiments performed at 1.2g, 1.4g, 1.6g, 1.8g and 2g basal tension and KCl induced AT recorded.
Results: In human pulmonary artery rings increasing the basal tension from 1.0 g to 1.6 g significantly augmented the 40mM KCl induced active tension. Increasing the active tension from 1.6 g to 2.0 g either decreased or plateaued the 40mM KCl induced response. Both organ bath and myograph shows similar result and confirmed that optimal RT for human pulmonary artery rings to be 1.61 g. The optimal resting tension in our experiment was 1.61 g for pulmonary artery ring.
Conclusion: More studies are needed to validate this data and also to identify if the optimal resting tension is different in different size pulmonary arteries.
University of Manchester, UK
Title: Investigating the role of plasma membrane calcium ATPase subtype 4 (PMCA4) in cardiac electrical activity
Time : 15:10-15:35
Mohamed Elsakka was awarded half a scholarship, free of charge grant, by Mansoura University due to his good performance in high school. He has gained his Bachelor of Medicine and Surgery (MBBCh Degree) from Mansoura-Manchester Programme for Medical Education, Mansoura University, Egypt, with excellent degree with honour, and he was one of the top five students of his class. Afterwards, he started working as a Cardiothoracic resident at Mansoura University Hospitals. He is fully registered with the GMC, and has applied for his Master’s Degree in Cardiovascular research at the University of Manchester under supervision of Dr. Elizabeth Cartwright.
Heart failure (HF) confers a poor prognosis with an annual 30-40% mortality rate for patients. 40% of HF-related mortality is linked to a sudden arrhythmic event. Increased intracellular calcium has been observed in failing cardiomyocytes, and attention has been drawn to calcium handling and cardiac electrical activity in these cells. Plasma membrane calcium ATPases (PMCA), a family of calcium-extrusion pumps, were found to contribute little to total calcium-extrusion processes in normal cardiomyocytes but can be activated by Ca2+-dependent processes. We have previously shown that PMCA4 is part of a protein complex which modulates localised Ca2+ levels in cardiomyocytes. We have found that genetic ablation of PMCA4 (PMCA4KO) protected against hypertrophy-induced HF in mice. However, little is known about how PMCA4 may influence arrhythmic events. Therefore, we sought to assess PMCA4s
role in cardiac electrical signalling. We report that no significant difference was found in any ECG parameters between PMCA4KO and PMCA4 wild-type mice in either conscious or unconscious ECG. No significant difference was found in gene expression of calcium handling proteins. However, in PMCA4KO mice, a trend was seen for reduced expression of potassium channels, including Kir2.1 (inward-rectifier channel encoded by KCNJ2), Kv1.4 and Kv4.2 (transient-outward channels encoded by KCNA4 and KCND2 respectively). Such channels have important roles in cardiac repolarisation, which governs the action potential duration. This study,
so far, has found no significant difference in cardiac electrical activity between PMCA4KO and PMCA4 wild-type mice under basal conditions. Further assessment under arrhythmic stress and hypertrophic conditions is required.
Castle Hill Hospital, UK
Time : 15:35-16:00
Azar Hussain has completed his MBBS from Pakistan and completed his MRCS from Royal College of Surgeons of Edinburgh. He completed his MSc in Translational Research in cardiovascular medicine from University of Bristol. Currently, he is pursuing his MD on ‘Effect of oxygen on small human pulmonary artery’ from Hull York Medical School. He is also pursuing a diploma in Post-graduate research training and an MSc in Healthcare Improvement leadership. He published 5 papers in reputed journals and delivered talks on both national and international cardiothoracic forum.
Little data are available on the characterization of the basic physiological pulmonary vascular reactivity to vasoconstrictors. The aim of this study was to characterize pharmacological properties of human pulmonary artery (PA). Patients undergoing lung resection were consented for inclusion in this study. Research ethics committee approval was obtained and total 19 patients were enrolled for this study. Pulmonary arteries dissected from disease free areas of lung resection and 57 PA rings of internal diameter 2-4 mm and 2mm long were prepared. Integrity of endothelium was confirmed with 1uM acetylcholine and KCl was used to check the contractility of PA rings. Multi-wire myograph system was used to mount the PA rings under physiological conditions in modified Krebs solution. A basal tension of 1.61gm was applied and the rings were left to equilibrate for 60 min. After equilibration increasing concentration of potassium chloride, Nor-adrenaline, Adrenaline, Vasopressin, Endothelin-1 and Prostaglandin F2a were used. Endothelin 1 was the most potent vasoconstrictor and PGF2a and KCl are equally highly efficacious. Vasopressin had no effect on the pulmonary artery while adrenaline and noradrenalin resulted in significant increase in pulmonary contraction. This study demonstrated the differential effect of vasoconstrictors on pulmonary vessels. Vasopressin may be safe to use for systemic vasoconstriction in patients with pulmonary hypertension.
Szeged University, Hungary
Title: Consequences of exercising on ischemia-reperfusion injury in type 2 diabetic Goto-Kakizaki rat hearts: Role of the HO/NOS system
Time : 16:15-16:35
Amin Al-awar is a PhD student at University of Szeged. He is currently conducting research at the Biology Doctoral School/ Faculty of Sciences and Informatics, specifically in the department of Physiology, Anatomy and Neurosciences at Csaba Varga’s Endocrinology Lab, as he is the head of the department too. His PhD studies and research is under the supervision of Dr. Krisztina Kupai, who holds a PharmD and PhD degree and in her account around 30 papers published in international and reputed journals in the field of Diabetes and Cardiovascular diseases. He is also a member in the European Cardiovascular Society.
It is well established that physical exercise continues to be one of the most valuable forms of non-pharmacological therapy against diabetes mellitus; however, the precise mechanism remains unknown. The aim of this study was to investigate the cardio-protective effect of voluntary exercise in the Goto-Kakizaki type 2 diabetic rat hearts against ischemia reperfusion injury and to clarify its biochemical background, focusing on the nitric oxide synthase/hemeoxygenase system.
Karlsruhe Institute of Technology, Germany
Title: Dynamics of rotational and focal drivers in persistent atrial fibrillation at cardiac fibrosis -A clinical mapping and simulation study
Time : 16:35-17:00
Markus Rottmann has completed his Master of Science degree from Karlsruhe Institute of Technology (KIT), Germany. Currently, he is pursuing PhD in Biomedical Engineering at the Institute of Biomedical Engineering, KIT. He is engaged in research on Computational Cardiology.
Introduction: Persistent atrial fibrillation (AF) is associated with increased prevalence of atrial fibrosis. However, the role of fibrosis in arrhythmogenesis for AF is not well understood.
Methods: Clinical data of 18 patients with persistent AF and AF termination by ablation were analysed with regard to spatial relationship of AF termination sites and low voltage areas (LVA<0.5mV). For the first time, numerical simulations in 3D human atrial models assessed the impact of variable size and degree of myocardial fibrosis (DoF) on development and stability of focal and re-entrant sources in AF. Conduction velocity (CV), fiberorientation, pacing frequency and repetition of sources were analyzed.
Results: 14/18 (78%) of AF termination sites located to low voltage areas (0.5mV) and 4/18 (22%) to borderzones (<1cm distance to LVA). Simulations of persistent AF in a 3D-atrial model with regional fibrosis revealed stable (>20 AF cycles) anchoring of meandering rotational and focal sources within fibrosis (<5mm of borders). Rotational excitation wavefronts spread out from fibrosis area to healthy tissue, resulting in focal-like excitation patterns. However, the focal sources originated from variable locations around the fibrosis borders, potentially leading to beat-to-beat variabilities in the electrogram morphology. CV was 1 m/s within healthy tissue, 0.2 m/s at fibrosis > 40% and 0.4 m/s at fibrosis 30-40%. With increasing degree of fibrosis, electrogram amplitudes decreased but the cycle lengths, stability and consistency of sources increased.
Conclusions: Region of increased atrial fibrosis display low voltage amplitudes and harbour rotational and focal sources responsible
King Saud University, Saudi Arabia
Title: Compliance with and awareness about oral anticoagulant therapy among Saudi patients in a University hospital Riyadh, Saudi Arabia
Time : 17:00-17:25
Shehanah Fahad Al Omair is currently a final year medical student at King Saud University- College of medicine in Riyadh, Saudi Arabia. She is interested in
otolaryngology as a specialty but the field of research has always been intriguing to her. She has four researches; two of them are in the process of being published.
Background & Aim: Oral anticoagulant therapy (OAT) is one of the most widely used therapies. Being on oral anticoagulation regimens requires high degree of compliance and adequate knowledge to avoid serious complications. Our aim is to assess compliance with and awareness about OAT among Saudi patients and their willingness to use the point-of-care (POC) INR testing devices for self- monitoring.
Methods: A self-administered questionnaire was carried out for all patients and analyzed according to demographics, adherence; knowledge and INR control. A total of 162 patients were interviewed, females (69.1%) exceeded males (30.1%). The mean age was 52.09±15.34. Most of them were on warfarin, (80.2%) received education by their physicians. Generally, patients had poor knowledge and medium adherence (53.1%) (Scored<50%).
Results: (24%) of the Poor Knowledge Group (PKG) were highly adherent compared to (14.5%) of the Fine Knowledge Group (FKG). However, (53.2%) of FKG had a controlled INR where this percentage falls into (27%) in the PKG, with a significant difference between the two regarding their INR range (p=0.001). The most incorrect answered question in both groups was related to warfarindrug-interactions (75.3%). Majority (74.7%) was eager to make use of the POC-INR devices.
Conclusion: The participants knowledge was generally poor but level of knowledge didn’t play a role in INR control. Regardless, an education program should be accommodated to help patients in improving their medication control and reducing clinical visits. The majority was willing to adopt (POC) INR devices that will certainly help them in managing their treatment and potentially reducing adverse clinical outcomes.
- Video Presentation
Sergio Mejia Viana
Medical Investigation Unit. St Bernard´s Hospital., Gibraltar
Medical Investigation Unit. St BernardÂ´s Hospital., Gibraltar
Sergio Mejía Viana has completed his Cardiology training and Doctorate at the University Clinic of Navarre. He was an interventional Cardiologist, Angiologist and Phlebologist for 20 years. He is a Fellow of the European Society of Cardiology, has written more than 100 scientific publications including abstracts, articles and book chapters. He returned to clinical practice with high interest in prevention. Currently, he is a Consultant at the Medical Investigation Unit in St. Bernard´s Hospital in Gibraltar.
There is increasing concern regarding the health effects of exposure to various heavy metals in the environment. This is particularly true for mercury, cadmium, lead, aluminum and arsenic. The cardiovascular consequences of metal toxicity have not been published widely enough because of some sort of misunderstanding of the cholesterol role and the atherosclerosis pathological findings. Lead exposure increased through the mid 1970´s, largely as a result of use of tetraethyl lead in gasoline. At the peak of lead production, the atmospheric release of lead reached 600.000 tons annually. The half-life of lead in the body is extremely long as it accumulates in the bone. The association between lead and cardiovascular disease has been recognized for years and there is consistent epidemiological evidence that lead is an established risk factor for hypertension, promotes oxidative stress and inflammation, the triggering event of atherosclerosis. Cadmium production increased during the 20th century as a result of the production of nickel-cadmium batteries, metal coatings and plastic stabilizers. Food and smoking are the major sources of cadmium for the general population. Once ingested, cadmium is stored in the kidneys, liver, lungs, pancreas and central nervous system, with a half-life of over 15 to 45 years. A recent systematic review concluded that the evidence supports the role of cadmium as a cardiovascular disease risk factor, especially for coronary disease. Understanding that atherosclerosis is an inflammatory disease and not “fat deposits blocking arteries” will improve preventative strategies.