%PDF-1.7
%
1 0 obj
<>>>
endobj
2 0 obj
<>stream
2015-09-09T09:05:43-04:00
2015-09-09T09:05:46-04:00
2015-09-09T09:05:46-04:00
Adobe InDesign CC 2014 (Windows)
uuid:ddd9db0b-385d-47a7-9244-cc6f22352900
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
xmp.id:e7d0c999-6ee4-6347-b6bc-ce233e9b08d3
proof:pdf
xmp.iid:a31d01e2-c682-8f4a-84c1-b319f1620039
xmp.did:2ad53760-cd5f-414f-86cc-7238d986e445
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
default
converted
from application/x-indesign to application/pdf
Adobe InDesign CC 2014 (Windows)
/
2015-09-09T09:05:43-04:00
application/pdf
Adobe PDF Library 11.0
False
endstream
endobj
3 0 obj
<>
endobj
5 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
6 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
20 0 obj
<>stream
BT
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
7 0 0 7 60.48 22.6817 Tm
(2 )Tj
/Span<>> BDC
( )Tj
EMC
56.231 0 Td
[(Clinical Briefs in P)18.1(rimary Care)]TJ
ET
q
0 g
/GS1 gs
/Fm0 Do
Q
BT
/T1_0 1 Tf
-0.03 Tc 7 0 0 7 40.75 351.44 Tm
(CLINICAL BRIEFS IN PRIMARY CARE)Tj
/T1_1 1 Tf
0 Tc 6 0 0 6 154.1484 351.44 Tm
(\231 )Tj
1.19 0 Td
( )Tj
-0.03 Tc -20.09 -1.167 Td
[(is published monthly by AHC Media, LLC. Copyright \251 2015)-30( )]TJ
0 -1.167 TD
[(AHC Media, LLC.)-30( )]TJ
/T1_2 1 Tf
8 0 0 8 40.75 327.44 Tm
(Executive Editor:)Tj
/T1_1 1 Tf
( Leslie Coplin)Tj
/T1_2 1 Tf
0.03 Tw 0 -1.25 TD
(Editor:)Tj
/T1_1 1 Tf
0 Tw ( Stephen Brunton, MD)Tj
/T1_2 1 Tf
T*
(Associate Managing Editor:)Tj
/T1_1 1 Tf
[( Jonathan)-30( )]TJ
0.03 Tw T*
(Springston)Tj
0 Tw 6 0 0 6 40.75 283.44 Tm
[(This is an educational publication designed to present)-29.9( )]TJ
0 -1.167 TD
[(scientific information and opinion to health professionals,)-30( )]TJ
0 -1.167 TD
[(stimulate thought, and further investigation. It does not)-30( )]TJ
0 -1.167 TD
[(provide advice regarding medical diagnosis or treatment for)-30( )]TJ
T*
(any individual case. It is not intended for the layman.)Tj
0 -1.917 TD
(STATEMENT OF FINANCIAL DISCLOSURE)Tj
0 -1.167 TD
[(To reveal any potential bias in this publication, and in)-30( )]TJ
T*
[(accordance with Accreditation Council for Continuing)-30( )]TJ
0 -1.167 TD
[(Medical Education guidelines, Dr. Brunton \(editor\) reports)-30( )]TJ
0 -1.167 TD
[(he is a retained consultant for Abbott, AstraZeneca, Becton)-30( )]TJ
T*
[(Dickinson, Boehringer Ingelheim, Janssen, Lilly, Novo)-30( )]TJ
0 -1.167 TD
[(Nordisk, Sanofi, and Teva; and he serves on the speakers)-30( )]TJ
0 -1.167 TD
[(bureau of AstraZeneca, Boehringer Ingelheim, Janssen, Lilly,)-29.9( )]TJ
T*
[(Novo Nordisk, and Teva. Dr. Kuritzky \(author\) reports he is)-30( )]TJ
0 -1.167 TD
[(a retained consultant for AbbVie, AstraZeneca, Boehringer)-29.9( )]TJ
0 -1.167 TD
[(Ingelheim, Bristol-Myers Squibb, Chelsea, Daiichi Sankyo,)-30( )]TJ
T*
[(Forest Pharmaceuticals, Janssen, Lilly, Novo Nordisk, Pfizer,)-30( )]TJ
0 -1.167 TD
[(and Sanofi. Ms. Coplin \(executive editor\), and Mr. Springston)-30( )]TJ
0 -1.167 TD
[(\(associate managing editor\) report no financial relationships)-30( )]TJ
T*
(relevant to this field of study.)Tj
ET
/CS0 CS 1 SCN
0.25 w 4 M
/GS1 gs
36.125 46.125 165.734 315.19 re
S
/CS0 cs 0.1 scn
43.545 76.88 146.91 66.4 re
f
BT
0 0 0 1 k
/GS0 gs
/T1_2 1 Tf
0.05 Tc 8 0 0 8 48.0448 131.5801 Tm
[(SUBSCRIBER INFORMA)92(TION)]TJ
-0.01 Tc 7 0 0 7 48.0448 121.3041 Tm
(Customer Service: \(800\) 688-2421)Tj
/T1_1 1 Tf
6 0 0 6 48.0448 114.3041 Tm
(Email Address: jonathan.springston@ahcmedia.com)Tj
T*
(Website: AHCMedia.com)Tj
0 -1.917 TD
[(Address Correspondence to: AHC Media, One)-10( )]TJ
0 -1.167 TD
[(Atlanta Plaza, 950 East Paces Ferry Road NE, Suite)-10( )]TJ
T*
[(2850, Atlanta, GA 30326)-10( )]TJ
ET
/PlacedGraphic /MC0 BDC
EMC
q
81.64 47.558 70.72 27.882 re
W n
/GS1 gs
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -312.9144 -109.2741 cm
0 0 m
-0.09 0 l
-0.54 1.755 -1.035 3.87 -1.53 5.67 c
-3.87 13.14 l
3.914 13.14 l
1.53 5.67 l
0.945 3.825 0.45 1.755 0 0 c
f
Q
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -251.8959 -87.4949 cm
0 0 m
2.205 0 4.545 -0.45 6.03 -1.08 c
6.93 3.285 l
5.625 3.915 2.745 4.635 -0.945 4.635 c
-10.574 4.635 -16.424 -1.395 -16.424 -10.664 c
-16.424 -20.654 -9.449 -26.684 -0.18 -26.684 c
3.465 -26.684 6.03 -25.919 7.155 -25.334 c
5.985 -20.924 l
4.545 -21.554 2.52 -22.094 0.046 -22.094 c
-6.12 -22.094 -10.574 -18.225 -10.574 -10.935 c
-10.574 -4.23 -6.704 0 0 0 c
-20.25 4.14 m
-25.785 4.14 l
-25.785 -9.225 l
-38.609 -9.225 l
-38.609 4.14 l
-44.144 4.14 l
-44.144 -26.189 l
-38.609 -26.189 l
-38.609 -14.039 l
-25.785 -14.039 l
-25.785 -26.189 l
-20.25 -26.189 l
h
-53.459 4.14 m
-56.204 -4.455 l
-65.788 -4.455 l
-68.398 4.14 l
-74.113 4.14 l
-64.393 -26.189 l
-57.329 -26.189 l
-47.474 4.14 l
h
-85.291 40.499 104.497 -104.497 re
-85.291 -63.998 m
f
Q
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -193.3073 -95.7297 cm
0 0 m
-0.18 -3.915 -0.405 -8.64 -0.36 -12.734 c
-0.495 -12.734 l
-1.485 -9.044 -2.745 -4.95 -4.095 -1.125 c
-8.55 12.015 l
-12.779 12.015 l
-16.829 -0.945 l
-18 -4.815 -19.079 -8.955 -19.889 -12.734 c
-19.979 -12.734 l
-20.114 -8.774 -20.294 -3.96 -20.519 0.18 c
-21.195 12.375 l
-26.369 12.375 l
-24.344 -17.954 l
-17.054 -17.954 l
-13.094 -5.76 l
-12.015 -2.205 -11.07 1.395 -10.305 4.77 c
-10.17 4.77 l
-9.36 1.485 -8.325 -2.25 -7.155 -5.805 c
-2.97 -17.954 l
4.23 -17.954 l
5.985 12.375 l
0.585 12.375 l
h
f
Q
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -168.1523 -96.6296 cm
0 0 m
0.045 -2.025 -0.855 -5.355 -4.545 -5.355 c
-7.965 -5.355 -9.405 -2.25 -9.63 0 c
h
-9.63 3.87 m
-9.495 7.83 -6.435 9.539 -2.88 9.539 c
-0.315 9.539 1.485 9.135 3.194 8.55 c
4.004 12.33 l
2.115 13.14 -0.495 13.725 -3.645 13.725 c
-10.755 13.725 -14.94 9.359 -14.94 2.655 c
-14.94 -3.42 -11.25 -9.135 -4.23 -9.135 c
2.879 -9.135 5.219 -3.285 5.219 1.53 c
5.219 2.565 5.129 3.375 5.04 3.87 c
h
f
Q
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -143.8083 -96.1344 cm
0 0 m
0 -0.45 -0.045 -1.035 -0.134 -1.485 c
-0.63 -3.6 -2.384 -5.355 -4.904 -5.355 c
-8.459 -5.355 -10.439 -2.205 -10.439 1.845 c
-10.439 5.894 -8.459 8.819 -4.949 8.819 c
-2.699 8.819 -0.719 7.289 -0.179 4.905 c
-0.045 4.41 0 3.87 0 3.285 c
h
5.535 -19.169 m
5.535 6.615 l
5.535 8.864 5.625 11.294 5.715 12.779 c
0.81 12.779 l
0.54 9.314 l
0.451 9.314 l
-0.855 11.744 -3.509 13.274 -6.659 13.274 c
-11.924 13.274 -16.064 8.819 -16.064 2.07 c
-16.109 -5.265 -11.519 -9.63 -6.254 -9.63 c
-3.239 -9.63 -1.08 -8.415 -0.09 -6.795 c
0 -6.795 l
0 -19.169 l
h
f
Q
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
-132.333 -105.269 5.536 21.914 re
-132.333 -83.355 m
-126.438 -111.389 m
-126.438 -109.769 -127.652 -108.419 -129.587 -108.419 c
-131.433 -108.419 -132.648 -109.769 -132.648 -111.389 c
-132.648 -113.099 -131.387 -114.404 -129.543 -114.404 c
-127.652 -114.404 -126.482 -113.099 -126.438 -111.389 c
f
Q
q
0.3025548 0 0 -0.2668247 183.6575317 35.0179443 cm
q 1 0 0 1 -109.2033 -94.0647 cm
0 0 m
-3.914 -0.045 -7.65 0.765 -7.65 4.095 c
-7.65 6.255 -6.255 7.245 -4.5 7.245 c
-2.25 7.245 -0.675 5.805 -0.135 4.23 c
0 3.825 0 3.42 0 3.015 c
h
5.4 5.445 m
5.4 7.425 5.49 9.359 5.76 10.71 c
0.765 10.71 l
0.36 8.28 l
0.225 8.28 l
-1.08 9.99 -3.375 11.205 -6.255 11.205 c
-10.664 11.205 -13.139 8.01 -13.139 4.68 c
-13.139 -0.81 -8.235 -3.645 -0.135 -3.6 c
-0.135 -3.96 l
-0.135 -5.4 -0.72 -7.785 -4.59 -7.785 c
-6.749 -7.785 -8.999 -7.11 -10.485 -6.165 c
-11.565 -9.765 l
-9.945 -10.755 -7.11 -11.7 -3.645 -11.7 c
3.375 -11.7 5.4 -7.245 5.4 -2.43 c
h
f
Q
Q
Q
1 w 10 M
/GS1 gs
q 1 0 0 1 36 473.1495 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 36 438.1495 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
/T1_3 1 Tf
-0.02 Tc 9 0 0 9 36 737.0496 Tm
[(usual care to intensive intervention, more)-20( )]TJ
0 -1.2 TD
[(subjects in the intensive intervention group)-20( )]TJ
0 -1.2 TD
[(were treated with statins, beta-blockers,)-20( )]TJ
0 -1.2 TD
[(and aspirin, and fewer persons smoked.)-20( )]TJ
T*
[(When these same metrics were plugged)-20( )]TJ
T*
[(into the Michigan Model for T)86(ype 2)-20( )]TJ
0 -1.2 TD
[(Diabetes, and the potential number of)-20( )]TJ
0 -1.2 TD
[(participants substantially increased \(to)-20( )]TJ
0 -1.2 TD
[(6815\), early detection through screening)-20( )]TJ
T*
[(and intensive treatment was associated with)-20( )]TJ
T*
[(a 29% relative risk reduction in CV events)-20( )]TJ
0 -1.2 TD
[(compared to an unscreened population)-20( )]TJ
0 -1.2 TD
[(diagnosed 6 years later and receiving usual)-20( )]TJ
0 -1.2 TD
[(care. T)98(o date, a reduction in CV mortality)-20( )]TJ
T*
[(has not been demonstrated within the)-20( )]TJ
T*
[(con\036nes of a randomized, controlled trial of)-20( )]TJ
0 -1.2 TD
[(glucose treatment in diabetes. Multifactorial)-20( )]TJ
0 -1.2 TD
[(trials in which blood pressure, lipids,)-20( )]TJ
0 -1.2 TD
[(weight, exercise, and glucose are)-20( )]TJ
T*
[(concomitantly addressed have produced)-20( )]TJ
T*
[(favorable CV risk reduction, but it becomes)-20( )]TJ
0 -1.2 TD
[(dif\036cult to ascertain which component\(s\))-20( )]TJ
0 -1.2 TD
[(of the multipronged intervention is most)-20( )]TJ
0 -1.2 TD
(responsible for the bene\036cial outcomes. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 186.6402 488.6495 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
14 0 0 14 36 459.1495 Tm
[(CAN Occurs Earlier in T)176.1(ype )]TJ
0 -1.143 TD
(2 Diabetes)Tj
/TT1 1 Tf
9 0 0 9 36 420.3495 Tm
[(SOURCE: Zoppini G, et al. P)35(revalence of )]TJ
0 -1.2 TD
(cardiovascular autonomic neuropathy in a )Tj
T*
(cohort of patients with newly diagnosed type )Tj
T*
[(2 diabetes: The V)54.1(erona Newly Diagnosed )]TJ
T*
[(T)174.7(ype 2 Diabetes Study \(VNDS\). )]TJ
/TT2 1 Tf
(Diabetes Care)Tj
/TT1 1 Tf
17.653 0 Td
( )Tj
-17.653 -1.2 Td
(2015;38:1487-1493.)Tj
ET
/GS1 gs
q 1 0 0 1 214.008 362.1834 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 214.008 327.1834 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
/TT0 1 Tf
30.3235 0 0 30.3235 213.8007 723.2834 Tm
(T)Tj
/T1_3 1 Tf
-0.02 Tc 9 0 0 9 231.7763 734.0834 Tm
[(he most common neuropathy seen in)-20( )]TJ
T*
[(type 2 diabetes \(T2DM\) is symmetrical)-20( )]TJ
-1.974 -1.2 Td
[(distal neuropathy)92(, which usually affects)-20( )]TJ
T*
[(both lower extremities. T2DM is also)-20( )]TJ
0 -1.2 TD
[(characterized by a variety of autonomic)-20( )]TJ
0 -1.2 TD
[(neuropathies that have the potential)-20( )]TJ
0 -1.2 TD
[(to impact adrenergic, cholinergic, and)-20( )]TJ
T*
[(dopaminergic pathways. Cardiovascular)-20( )]TJ
T*
[(autonomic neuropathy \(CAN\) may include)-20( )]TJ
0 -1.2 TD
[(neuropathy to the heart and vasculature.)-20( )]TJ
0 -1.2 TD
[(Sympathetic overactivity in CAN has been)-20( )]TJ
0 -1.2 TD
[(associated with arrhythmias and sudden)-20( )]TJ
T*
[(cardiac death. Con\036rmation of CAN)-20( )]TJ
T*
[(requires somewhat sophisticated tests,)-19.9( )]TJ
0 -1.2 TD
[(and there has been some inconsistency of)-20( )]TJ
0 -1.2 TD
[(diagnostic criteria, both of which have likely)-20.1( )]TJ
0 -1.2 TD
[(contributed to a low level of awareness of)-20( )]TJ
T*
[(CAN and its consequences. The V)74(erona)-20( )]TJ
T*
[(Newly Diagnosed T2DM Study \(n = 813\))-20( )]TJ
0 -1.2 TD
[(included a large subgroup of subjects who)-20( )]TJ
0 -1.2 TD
[(agreed to undergo cardiac autonomic testing)-20( )]TJ
0 -1.2 TD
[(\(n = 557\). Depending on the strictness of)-20( )]TJ
T*
[(testing criteria, the prevalence of CAN was)-20( )]TJ
T*
[(at least 1.8% at baseline \(strict criteria\), but)-20( )]TJ
T*
[(as high as 15.3% when less strict criteria)-20( )]TJ
T*
[(were utilized. Clinicians typically have)-20( )]TJ
T*
[(thought of neuropathic changes in T2DM as)-20( )]TJ
T*
[(a re\037ection of long-term disease. This study)-20( )]TJ
T*
[(is the largest population study of newly)-20( )]TJ
T*
[(diagnosed persons with T2DM that studied)-20( )]TJ
T*
[(CAN at baseline. These results suggest)-19.9( )]TJ
T*
[(that CAN may occur quite early)92(. Whether)-20( )]TJ
T*
[(treatment of diabetes might alter the course)-20( )]TJ
T*
(of CAN remains unknown. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 320.5222 377.6834 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
14 0 0 14 214.008 348.1834 Tm
(Approaches to PTSD)Tj
( )Tj
0 -1.143 TD
[(in V)55(eterans)]TJ
/TT1 1 Tf
9 0 0 9 214.008 309.3834 Tm
[(SOURCE: P)54.6(olusny MA, et al. Mindfulness-based )]TJ
0 -1.2 TD
(stress reduction for post-traumatic stress disor)Tj
17.523 0 Td
(-)Tj
-17.523 -1.2 Td
(der among veterans: A randomized clinical trial. )Tj
/TT2 1 Tf
T*
(JAMA)Tj
/TT1 1 Tf
( 2015;314:456-465.)Tj
/TT0 1 Tf
30.3235 0 0 30.3235 211.787 246.3834 Tm
(P)Tj
/T1_3 1 Tf
-0.02 Tc 9 0 0 9 227.6157 257.1834 Tm
[(TSD among veterans deployed in)-20( )]TJ
T*
[(recent years to Afghanistan and Iraq is)-20( )]TJ
-1.512 -1.2 Td
[(commonplace and potentially debilitating.)-20( )]TJ
T*
[(Unfortunately)92(, 30-50% of PTSD sufferers)-20( )]TJ
T*
[(who receive treatment with traditional)-20( )]TJ
T*
[(psychological interventions do not enjoy)-20( )]TJ
T*
[(signi\036cant improvement. Mindfulness-based)-20( )]TJ
T*
[(stress reduction \(MBSR\) might be most)-20( )]TJ
T*
[(simply described as \223emotionally detached)-20( )]TJ
T*
[(self-observation.\224 PTSD patients might be)-20( )]TJ
T*
[(instructed to view the symptoms they are)-20( )]TJ
T*
[(experiencing as a dispassionate external)-20( )]TJ
T*
[(observer might, and instead of responding)-20( )]TJ
T*
[(to their symptoms, simply take note of their)-20( )]TJ
T*
[(symptoms in a non-judgmental fashion.)-20( )]TJ
T*
[(Instead of continued focus on troubling or)-20( )]TJ
T*
[(emotionally labile thoughts, patients can)-20( )]TJ
T*
[(be taught to focus on breathing, muscle)-20( )]TJ
T*
[(tone, and stretching. In this clinical trial \(n)-20( )]TJ
T*
(= 116\), MBSR was compared with present-)Tj
ET
/GS1 gs
q 1 0 0 1 392.016 559.5496 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 392.016 524.5496 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
9 0 0 9 392.016 737.0496 Tm
[(centered group therapy)92(, an intervention)-20( )]TJ
0 -1.2 TD
[(already demonstrated to provide positive)-20( )]TJ
0 -1.2 TD
[(outcomes in PTSD patients. Outcomes were)-20( )]TJ
0 -1.2 TD
[(measured at 3, 6, 9, and 17 weeks. MBSR)-20( )]TJ
T*
[(provided better symptom improvement)-20( )]TJ
T*
[(than present-centered group therapy)92(. On the)-20( )]TJ
0 -1.2 TD
[(other hand, the number of persons who no)-20( )]TJ
0 -1.2 TD
[(longer ful\036lled diagnostic criteria for PTSD)-20( )]TJ
0 -1.2 TD
[(2 months after conclusion \(i.e., \223remission\224)-20( )]TJ
T*
[(of PTSD\) of the interventions was)-20( )]TJ
T*
[(comparable in both groups. MBSR shows)-20( )]TJ
0 -1.2 TD
[(promise as a valuable intervention for PTSD)-20( )]TJ
0 -1.2 TD
[(patients. Of course, PTSD may ultimately)-20( )]TJ
0 -1.2 TD
[(require combinations of psychological)-20( )]TJ
T*
[(and/or lifestyle interventions, as well as)-20( )]TJ
T*
[(pharmacotherapy)92(. )]TJ
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 463.9524 575.0496 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
14 0 0 14 392.016 545.5496 Tm
[(R)17.6(osacea is Associated)]TJ
( )Tj
0 -1.143 TD
(with Cardiovascular Disease)Tj
/TT1 1 Tf
9 0 0 9 392.016 506.7495 Tm
[(SOURCE: Hua T)54.5(C, et al. Cardiovascular )]TJ
0 -1.2 TD
(comorbidities in patients with rosacea: A nation)Tj
17.992 0 Td
(-)Tj
-17.992 -1.2 Td
[(wide case-control study from T)155.5(aiwan. )]TJ
/TT2 1 Tf
[(J Am A)-18.2(cad )]TJ
T*
(Dermatol)Tj
/TT1 1 Tf
( 2015;73:249-254.)Tj
/TT0 1 Tf
30.3235 0 0 30.3235 389.8394 443.7495 Tm
(R)Tj
/T1_3 1 Tf
-0.02 Tc 9 0 0 9 406.364 454.5495 Tm
[(ecent innovations in pharmacotherapy)-20( )]TJ
0 Tc 16.096 0 Td
( )Tj
-0.02 Tc -16.096 -1.2 Td
[( speci\036cally targeting immunologic)-20( )]TJ
-1.594 -1.2 Td
[(pathways have led to the ability to offer)-20( )]TJ
T*
[(remission of disorders like rheumatoid)-20( )]TJ
T*
[(arthritis \(RA\) and psoriasis. T)98(o some degree,)-20( )]TJ
T*
[(the promise of dramatic disease-altering)-20( )]TJ
T*
[(therapies has led to a heightened awareness)-20( )]TJ
T*
[(of these disorders among primary care)-20( )]TJ
T*
[(clinicians. At the same time, increased)-20( )]TJ
T*
[(detection and referral of RA and psoriasis)-20( )]TJ
T*
[(has been accompanied by a new focus on)-20( )]TJ
T*
[(the association between such disorders)-20( )]TJ
T*
[(and cardiovascular \(CV\) adversities. Some)-20( )]TJ
T*
[(experts have suggested RA be included in)-20( )]TJ
T*
[(CV risk assessment scoring systems, since)-20( )]TJ
T*
[(the impact of RA upon CV risk is similar to)-20( )]TJ
T*
[(that of the other primary CV risk factors,)-20( )]TJ
T*
[(such as dyslipidemia. The cause of rosacea)-20( )]TJ
T*
[(remains unknown, but it is generally)-20( )]TJ
T*
[(categorized as an in\037ammatory dermatosis,)-20( )]TJ
T*
[(categorically similar to psoriasis. Hua et)-20( )]TJ
T*
[(al investigated the relationship between)-20( )]TJ
T*
[(rosacea and cardiovascular disease using)-20( )]TJ
T*
[(data from the National Health Insurance)-20( )]TJ
T*
[(Research Database in T)86(aiwan. Among the)-20( )]TJ
T*
[(33,553 patients identi\036ed with rosacea,)-20( )]TJ
T*
[(there was an increased risk for hypertension,)-20( )]TJ
T*
[(dyslipidemia, coronary artery disease,)-20( )]TJ
T*
[(and peripheral arterial disease. While the)-20( )]TJ
T*
[(mechanism for the relationship between)-20( )]TJ
T*
[(rosacea and CV disease is ill-de\036ned at)-20( )]TJ
T*
[(this point, one postulate is that systemic)-20( )]TJ
T*
[(in\037ammation, which has been shown to)-20( )]TJ
T*
[(alter the ability of lipoproteins to remove)-20( )]TJ
T*
[(cholesterol from circulation, might be at)-20( )]TJ
T*
(least part of the explanation. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 503.2821 76.5496 Tm
<0084>Tj
ET
endstream
endobj
25 0 obj
<>>>/Subtype/Form>>stream
0 0 0 1 K
3 w 4 M 0 j 0 J
/GS0 gs
q 1 0 0 1 18 754.5 cm
0 0 m
558 0 l
S
Q
endstream
endobj
10 0 obj
<>
endobj
24 0 obj
<>
endobj
26 0 obj
<>stream
application/postscript
AHCmedia(New)_3 tag options_11.8.13
Travis
2014-09-09T14:01:27-04:00
2014-09-09T14:01:27-04:00
2014-09-09T14:01:27-04:00
Adobe Illustrator CC 2014 (Windows)
xmp.iid:bdec626a-762d-6946-8d41-56d8de9e49a7
xmp.did:bdec626a-762d-6946-8d41-56d8de9e49a7
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
xmp.iid:13a2ed22-31ef-3e4e-8ae1-9e6a4d59884d
xmp.did:13a2ed22-31ef-3e4e-8ae1-9e6a4d59884d
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
converted
from application/pdf to <unknown>
saved
xmp.iid:D27F11740720681191099C3B601C4548
2008-04-17T14:19:15+05:30
Adobe Illustrator CS4
/
converted
from application/pdf to <unknown>
converted
from application/pdf to <unknown>
saved
xmp.iid:F97F1174072068118D4ED246B3ADB1C6
2008-05-15T16:23:06-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:FA7F1174072068118D4ED246B3ADB1C6
2008-05-15T17:10:45-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:EF7F117407206811A46CA4519D24356B
2008-05-15T22:53:33-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F07F117407206811A46CA4519D24356B
2008-05-15T23:07:07-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F77F117407206811BDDDFD38D0CF24DD
2008-05-16T10:35:43-07:00
Adobe Illustrator CS4
/
converted
from application/pdf to <unknown>
saved
xmp.iid:F97F117407206811BDDDFD38D0CF24DD
2008-05-16T10:40:59-07:00
Adobe Illustrator CS4
/
converted
from application/vnd.adobe.illustrator to <unknown>
saved
xmp.iid:FA7F117407206811BDDDFD38D0CF24DD
2008-05-16T11:26:55-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:FB7F117407206811BDDDFD38D0CF24DD
2008-05-16T11:29:01-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:FC7F117407206811BDDDFD38D0CF24DD
2008-05-16T11:29:20-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:FD7F117407206811BDDDFD38D0CF24DD
2008-05-16T11:30:54-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:FE7F117407206811BDDDFD38D0CF24DD
2008-05-16T11:31:22-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:B233668C16206811BDDDFD38D0CF24DD
2008-05-16T12:23:46-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:B333668C16206811BDDDFD38D0CF24DD
2008-05-16T13:27:54-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:B433668C16206811BDDDFD38D0CF24DD
2008-05-16T13:46:13-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F77F11740720681197C1BF14D1759E83
2008-05-16T15:47:57-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F87F11740720681197C1BF14D1759E83
2008-05-16T15:51:06-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F97F11740720681197C1BF14D1759E83
2008-05-16T15:52:22-07:00
Adobe Illustrator CS4
/
converted
from application/vnd.adobe.illustrator to application/vnd.adobe.illustrator
saved
xmp.iid:FA7F117407206811B628E3BF27C8C41B
2008-05-22T13:28:01-07:00
Adobe Illustrator CS4
/
converted
from application/vnd.adobe.illustrator to application/vnd.adobe.illustrator
saved
xmp.iid:FF7F117407206811B628E3BF27C8C41B
2008-05-22T16:23:53-07:00
Adobe Illustrator CS4
/
converted
from application/vnd.adobe.illustrator to application/vnd.adobe.illustrator
saved
xmp.iid:07C3BD25102DDD1181B594070CEB88D9
2008-05-28T16:45:26-07:00
Adobe Illustrator CS4
/
converted
from application/vnd.adobe.illustrator to application/vnd.adobe.illustrator
saved
xmp.iid:F87F1174072068119098B097FDA39BEF
2008-06-02T13:25:25-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F77F117407206811BB1DBF8F242B6F84
2008-06-09T14:58:36-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F97F117407206811ACAFB8DA80854E76
2008-06-11T14:31:27-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:0180117407206811834383CD3A8D2303
2008-06-11T22:37:35-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:F77F117407206811818C85DF6A1A75C3
2008-06-27T14:40:42-07:00
Adobe Illustrator CS4
/
saved
xmp.iid:2759AC6B4FA8E211B099CEB363CBA397
2013-04-18T13:43:03-04:00
Adobe Illustrator CS4
/
saved
xmp.iid:5E11DEB5A8216811822A8C4A5BB13D00
2014-01-03T17:39:31-05:00
Adobe Illustrator CS6 (Macintosh)
/
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:13a2ed22-31ef-3e4e-8ae1-9e6a4d59884d
2014-01-06T10:41:10-05:00
Adobe Illustrator CC (Windows)
/
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:bdec626a-762d-6946-8d41-56d8de9e49a7
2014-09-09T14:01:27-04:00
Adobe Illustrator CC 2014 (Windows)
/
Print
False
False
1
3.584901
1.584901
Inches
Black
Default Swatch Group
0
White
CMYK
PROCESS
0.000000
0.000000
0.000000
0.000000
Black
CMYK
PROCESS
0.000000
0.000000
0.000000
100.000000
CMYK Red
CMYK
PROCESS
0.000000
100.000000
100.000000
0.000000
CMYK Yellow
CMYK
PROCESS
0.000000
0.000000
100.000000
0.000000
CMYK Green
CMYK
PROCESS
100.000000
0.000000
100.000000
0.000000
CMYK Cyan
CMYK
PROCESS
100.000000
0.000000
0.000000
0.000000
CMYK Blue
CMYK
PROCESS
100.000000
100.000000
0.000000
0.000000
CMYK Magenta
CMYK
PROCESS
0.000000
100.000000
0.000000
0.000000
C=15 M=100 Y=90 K=10
CMYK
PROCESS
15.000000
100.000000
90.000000
10.000000
C=0 M=90 Y=85 K=0
CMYK
PROCESS
0.000000
90.000000
85.000000
0.000000
C=0 M=80 Y=95 K=0
CMYK
PROCESS
0.000000
80.000000
95.000000
0.000000
C=0 M=50 Y=100 K=0
CMYK
PROCESS
0.000000
50.000000
100.000000
0.000000
C=0 M=35 Y=85 K=0
CMYK
PROCESS
0.000000
35.000000
85.000000
0.000000
C=5 M=0 Y=90 K=0
CMYK
PROCESS
5.000000
0.000000
90.000000
0.000000
C=20 M=0 Y=100 K=0
CMYK
PROCESS
20.000000
0.000000
100.000000
0.000000
C=50 M=0 Y=100 K=0
CMYK
PROCESS
50.000000
0.000000
100.000000
0.000000
C=75 M=0 Y=100 K=0
CMYK
PROCESS
75.000000
0.000000
100.000000
0.000000
C=85 M=10 Y=100 K=10
CMYK
PROCESS
85.000000
10.000000
100.000000
10.000000
C=90 M=30 Y=95 K=30
CMYK
PROCESS
90.000000
30.000000
95.000000
30.000000
C=75 M=0 Y=75 K=0
CMYK
PROCESS
75.000000
0.000000
75.000000
0.000000
C=80 M=10 Y=45 K=0
CMYK
PROCESS
80.000000
10.000000
45.000000
0.000000
C=70 M=15 Y=0 K=0
CMYK
PROCESS
70.000000
15.000000
0.000000
0.000000
C=85 M=50 Y=0 K=0
CMYK
PROCESS
85.000000
50.000000
0.000000
0.000000
C=100 M=95 Y=5 K=0
CMYK
PROCESS
100.000000
95.000000
5.000000
0.000000
C=100 M=100 Y=25 K=25
CMYK
PROCESS
100.000000
100.000000
25.000000
25.000000
C=75 M=100 Y=0 K=0
CMYK
PROCESS
75.000000
100.000000
0.000000
0.000000
C=50 M=100 Y=0 K=0
CMYK
PROCESS
50.000000
100.000000
0.000000
0.000000
C=35 M=100 Y=35 K=10
CMYK
PROCESS
35.000000
100.000000
35.000000
10.000000
C=10 M=100 Y=50 K=0
CMYK
PROCESS
10.000000
100.000000
50.000000
0.000000
C=0 M=95 Y=20 K=0
CMYK
PROCESS
0.000000
95.000000
20.000000
0.000000
C=25 M=25 Y=40 K=0
CMYK
PROCESS
25.000000
25.000000
40.000000
0.000000
C=40 M=45 Y=50 K=5
CMYK
PROCESS
40.000000
45.000000
50.000000
5.000000
C=50 M=50 Y=60 K=25
CMYK
PROCESS
50.000000
50.000000
60.000000
25.000000
C=55 M=60 Y=65 K=40
CMYK
PROCESS
55.000000
60.000000
65.000000
40.000000
C=25 M=40 Y=65 K=0
CMYK
PROCESS
25.000000
40.000000
65.000000
0.000000
C=30 M=50 Y=75 K=10
CMYK
PROCESS
30.000000
50.000000
75.000000
10.000000
C=35 M=60 Y=80 K=25
CMYK
PROCESS
35.000000
60.000000
80.000000
25.000000
C=40 M=65 Y=90 K=35
CMYK
PROCESS
40.000000
65.000000
90.000000
35.000000
C=40 M=70 Y=100 K=50
CMYK
PROCESS
40.000000
70.000000
100.000000
50.000000
C=50 M=70 Y=80 K=70
CMYK
PROCESS
50.000000
70.000000
80.000000
70.000000
PANTONE 288 U
SPOT
100.000000
CMYK
100.000000
67.000002
0.000000
23.000000
PANTONE 313 C
SPOT
100.000000
CMYK
100.000000
0.000000
8.000200
13.000500
PANTONE 313 U
SPOT
100.000000
CMYK
100.000000
0.000000
8.000000
13.000000
PANTONE 187 U
SPOT
100.000000
CMYK
0.000000
100.000000
78.999299
19.999699
PANTONE 309 U
SPOT
100.000000
CMYK
100.000000
0.000000
8.999600
72.000098
Grays
1
C=0 M=0 Y=0 K=100
CMYK
PROCESS
0.000000
0.000000
0.000000
100.000000
C=0 M=0 Y=0 K=90
CMYK
PROCESS
0.000000
0.000000
0.000000
89.999400
C=0 M=0 Y=0 K=80
CMYK
PROCESS
0.000000
0.000000
0.000000
79.998800
C=0 M=0 Y=0 K=70
CMYK
PROCESS
0.000000
0.000000
0.000000
69.999700
C=0 M=0 Y=0 K=60
CMYK
PROCESS
0.000000
0.000000
0.000000
59.999100
C=0 M=0 Y=0 K=50
CMYK
PROCESS
0.000000
0.000000
0.000000
50.000000
C=0 M=0 Y=0 K=40
CMYK
PROCESS
0.000000
0.000000
0.000000
39.999400
C=0 M=0 Y=0 K=30
CMYK
PROCESS
0.000000
0.000000
0.000000
29.998800
C=0 M=0 Y=0 K=20
CMYK
PROCESS
0.000000
0.000000
0.000000
19.999700
C=0 M=0 Y=0 K=10
CMYK
PROCESS
0.000000
0.000000
0.000000
9.999100
C=0 M=0 Y=0 K=5
CMYK
PROCESS
0.000000
0.000000
0.000000
4.998800
Brights
1
C=0 M=100 Y=100 K=0
CMYK
PROCESS
0.000000
100.000000
100.000000
0.000000
C=0 M=75 Y=100 K=0
CMYK
PROCESS
0.000000
75.000000
100.000000
0.000000
C=0 M=10 Y=95 K=0
CMYK
PROCESS
0.000000
10.000000
95.000000
0.000000
C=85 M=10 Y=100 K=0
CMYK
PROCESS
85.000000
10.000000
100.000000
0.000000
C=100 M=90 Y=0 K=0
CMYK
PROCESS
100.000000
90.000000
0.000000
0.000000
C=60 M=90 Y=0 K=0
CMYK
PROCESS
60.000000
90.000000
0.003100
0.003100
Adobe PDF library 10.01
endstream
endobj
11 0 obj
<>
endobj
21 0 obj
<>
endobj
22 0 obj
<>
endobj
23 0 obj
<>
endobj
13 0 obj
<>
endobj
15 0 obj
<>
endobj
17 0 obj
<>
endobj
18 0 obj
<>
endobj
42 0 obj
<>
endobj
43 0 obj
<>stream
HdNV{q)>J\> i\?m 6eȷ<O/fst]~x{_Nϯ7ww˛oxx2r/?2އp?D??yz{qfzOt:m-_7͆"uDsF'OuOD'&2G'j~"7vG?j$O ?O'I?ɟ'$O ?O'I?ɟ'3,Ɵ?gYyV2ee*)U,S,XXVLbbY2Ų++*V(VTPXXQBbbE
ŊnL_//?R_/WU_W+*_WU_W+*_o7M7&o
o7M7&o
:zX.oز>*+zR9OS Mb
endstream
endobj
44 0 obj
<>stream
HtU TSW['}M*4E
R5 *^ŭj-j".*Uuu\pV-
=ͨ0{w ;,)Ce}C{DE%G lgV~=V5df_ I<&?7&QKi`vxA^Ps@I7
H / J)W\N|"Ŕf&O