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de Santiago González C, Ciudad Martín J, García Alonso MM. [Risk factor control, lifestyle intervention, and prescribed medication in a cohort of patients with ischemic heart disease]. Semergen 2024; 50:102175. [PMID: 38301397 DOI: 10.1016/j.semerg.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the recommended prevention measures in our health area for patients discharged after a myocardial infarction. METHODS This was a retrospective descriptive study that selected patients with acute coronary syndrome in our health area in the previous calendar year. Control of the risk factors observed at the time of the coronary event and at 1 year and medication prescribed 1 year after the episode were studied. Variables including age, sex, control of dyslipidemia, hypertension or diabetes mellitus, adherence to treatment and lifestyle habits were analyzed. RESULTS Risk factor control was insufficient and sometimes even unassessed at the time of infarction. Although a slight improvement was perceived, control remained insufficient 1 year later. Moreover, patients, particularly women, were undertreated: one fifth (20%) more men were receiving appropriate treatment than women year after the myocardial event. CONCLUSIONS An additional effort must be made compared to what is currently being done, both by specialists in Hospital Care and Primary Care, to carry out good control of risk factors, meaning the control of certain diseases such as diabetes, high blood pressure or dyslipidemia, as well as habits or lifestyles that increase the probability of suffering a cardiovascular event. Furthermore, it is important to avoid these cardiovascular diseases and their relapse to reinforce adherence to the prescribed treatments.
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Affiliation(s)
- C de Santiago González
- Medicina familiar y Comunitaria, Centro de Salud de Alaejos, Área de Atención Primaria de Valladolid Este, Valladolid, España.
| | - J Ciudad Martín
- Medicina Familiar y Comunitaria, Hospital Clínico de Valladolid y Área de Atención Primaria de Valladolid Este, Valladolid, España
| | - M M García Alonso
- Medicina Familiar y Comunitaria, Centro de Salud de Circunvalación, Gerencia de Atención Primaria de Valladolid Este, Valladolid, España
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Fleg JL, Forman DE, Berra K, Bittner V, Blumenthal JA, Chen MA, Cheng S, Kitzman DW, Maurer MS, Rich MW, Shen WK, Williams MA, Zieman SJ. Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circulation 2013; 128:2422-46. [PMID: 24166575 PMCID: PMC4171129 DOI: 10.1161/01.cir.0000436752.99896.22] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wong DTL, Puri R, Psaltis PJ, Worthley SG, Worthley MI. Acute ST-segment myocardial infarction—Evolution of treatment strategies. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.39087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sol BG, van der Graaf Y, van Petersen R, Visseren FL. The Effect of Self-Efficacy on Cardiovascular Lifestyle. Eur J Cardiovasc Nurs 2011; 10:180-6. [DOI: 10.1016/j.ejcnurse.2010.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 06/25/2010] [Accepted: 06/28/2010] [Indexed: 12/21/2022]
Affiliation(s)
- Berna G.M. Sol
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Rutger van Petersen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
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Raal F, Schamroth C, Blom D, Marx J, Rajput M, Haus M, Hussain R, Cassim F, Nortjé M, Vandehoven G, Temmerman AM. CEPHEUS SA: a South African survey on the undertreatment of hypercholesterolaemia. Cardiovasc J Afr 2011; 22:234-40. [PMID: 21922121 PMCID: PMC3721857 DOI: 10.5830/cvja-2011-044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/23/2011] [Indexed: 11/06/2022] Open
Abstract
AIM The aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipidlowering drugs (LLDs), and to identify possible patient and physician characteristics associated with failure, if any, to achieve low-density lipoprotein cholesterol (LDL-C) targets. METHODS The survey was conducted in 69 study centres in South Africa and recruited consecutive consenting patients who had been prescribed LLDs for at least three months. One visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Physicians and patients completed questionnaires regarding their knowledge, awareness and perceptions of hypercholesterolaemia and the treatment thereof. RESULTS Of the 3 001 patients recruited, 2 996 were included in the final analyses. The mean age was 59.4 years, and 47.5% were female. Only 60.5 and 52.3% of patients on LLDs for at least three months achieved the LDL-C target recommended by the NCEP ATP III/2004 updated NCEP ATP III and the Fourth JETF/South African guidelines, respectively. Being male, older than 40 years, falling into the lower-risk categories, compliance with the medication regimen, and patient knowledge that the LDL-C goal had been reached, were associated with the highest probability of attaining LDL-C goals. CONCLUSION The results of this survey highlight the sub-optimal lipid control achieved in many South African patients taking lipid-lowering therapy.
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Affiliation(s)
- F Raal
- Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
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Royo Bordonada MÁ, Lobos Bejarano JM, Millán Núñez-Cortés J, Villar Álvarez F, Brotons Cuixart C, Camafort Babkowski M, Guijarro Herráiz C, de Pablo Zarzosa C, Pedro-Botet Montoya J, Santiago Nocito AD. Dislipidemias: un reto pendiente en prevención cardiovascular. Documento de consenso CEIPC/SEA. Med Clin (Barc) 2011; 137:30.e1-30.e13. [DOI: 10.1016/j.medcli.2011.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
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Current cardiovascular risk management patterns with special focus on lipid lowering in daily practice in Switzerland. ACTA ACUST UNITED AC 2010; 17:363-72. [PMID: 20168234 DOI: 10.1097/hjr.0b013e328333c1d9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There may be a considerable gap between LDL cholesterol (LDL-C) and blood pressure (BP) goal values recommended by the guidelines and results achieved in daily practice. DESIGN Prospective cross-sectional survey of cardiovascular disease risk profiles and management with focus on lipid lowering and BP lowering in clinical practice. METHODS In phase 1, the cardiovascular risk of patients with known lipid profile visiting their general practitioner was anonymously assessed in accordance to the PROCAM-score. In phase 2, high-risk patients who did not achieve LDL-C goal less than 2.6 mmol/l in phase 1 could be further documented. RESULTS Six hundred thirty-five general practitioners collected the data of 23 892 patients with known lipid profile. Forty percent were high-risk patients (diabetes mellitus or coronary heart disease or PROCAM-score >20%), compared with 27% estimated by the physicians. Goal attainment rate was almost double for BP than for LDL-C in high-risk patients (62 vs. 37%). Both goals were attained by 25%. LDL-C values in phase 1 and 2 were available for 3097 high-risk patients not at LDL-C goal in phase 1; 32% of patients achieved LDL-C goal of less than 2.6 mmol/l after a mean of 17 weeks. The most successful strategies for LDL-C reduction were implemented in only 22% of the high-risk patients. CONCLUSION Although patients at high cardiovascular risk were treated more intensively than low or medium risk patients, the majority remained insufficiently controlled, which is an incentive for intensified medical education. Adequate implementation of Swiss and International guidelines would expectedly contribute to improved achievement of LDL-C and BP goal values in daily practice.
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Sol BG, van der Graaf Y, Brouwer B, Hickox SM, Visseren FL. The Effect of a Self-Management Intervention to Reduce Vascular Risk Factors in Patients with Manifestations of Vascular Diseases. Eur J Cardiovasc Nurs 2010; 9:132-9. [DOI: 10.1016/j.ejcnurse.2009.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 11/13/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Berna G.M. Sol
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Beate Brouwer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Sophie M.C. Hickox
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
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Bergandi L, Cordero M, Anselmino M, Ferraro G, Ravera L, Dalmasso P, Moiraghi C, Trevi GP, Ghigo D, Bosia A, Bergerone S. Altered nitric oxide/cGMP platelet signaling pathway in platelets from patients with acute coronary syndromes. Clin Res Cardiol 2010; 99:557-64. [PMID: 20467748 DOI: 10.1007/s00392-010-0157-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 04/07/2010] [Indexed: 11/28/2022]
Abstract
This study was aimed at evaluating whether the nitric oxide (NO)/cyclic GMP (cGMP) signaling pathway is altered in platelets from patients with an acute coronary syndrome (unstable angina and acute myocardial infarction). We investigated 10 patients with unstable angina (UA), 14 with acute myocardial infarction (AMI) and 14 age and sex-matched healthy subjects. The serum markers of platelet activation (sP-selectin), inflammation (TNF-alpha and erythrocyte sedimentation rate), thrombotic state (fibrinogen) and plaque disruption were significantly higher in both UA and AMI patients compared to the healthy controls. In their platelets we assessed the cGMP levels in basal conditions and after stimulation with sodium nitroprusside (SNP), and performed Western blot analysis of homogenates to measure the expression of soluble guanylate cyclase isoforms. Basal levels of cGMP (pmol/10(10) platelets) were significantly higher in platelets from UA patients (1,097 +/- 111; p < 0.0001) and AMI (1,122 +/- 77; p < 0.0001) compared to those collected from healthy controls (497 +/- 80). The platelets of AMI patients exhibited a lack of cGMP increase after SNP stimulation in comparison with UA patients. The phosphorylation of upstream (Akt1 protein kinase alpha and endothelial NO synthase) and downstream (vasodilator-stimulated phosphoprotein, VASP) signaling proteins of the NO/cGMP pathway was investigated: serine phosphorylation in Akt1, eNOS and VASP was enhanced in platelets from UA and AMI patients when compared to controls. Furthermore, in AMI patients the inhibitors of guanylate cyclase and cGMP-dependent protein kinase did not revert the VASP phosphorylation. These data suggest that platelets from AMI patients are more resistant to SNP stimulation, not only as cGMP production, but also in terms of VASP activation. From these ex vivo results we hypothesize that the increased inflammatory state which often accompanies patients with cardiovascular diseases might promote a platelet preactivation resulting in their reduced sensitivity to NO.
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Affiliation(s)
- Loredana Bergandi
- Dipartimento di Genetica, Biologia e Biochimica (Sezione di Biochimica), University of Torino, Via Santena 5/bis, 10126, Turin, Italy.
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The year 2009 in Clinical Research in Cardiology. Clin Res Cardiol 2010. [DOI: 10.1007/s00392-010-0126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hermans MP, Castro Cabezas M, Strandberg T, Ferrières J, Feely J, Elisaf M, Michel G, Sansoy V. Centralized Pan-European survey on the under-treatment of hypercholesterolaemia (CEPHEUS): overall findings from eight countries. Curr Med Res Opin 2010; 26:445-54. [PMID: 20001658 DOI: 10.1185/03007990903500565] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surveys evaluating plasma lipid goal attainment in patients with coronary heart disease have shown that hypercholesterolaemia is inadequately treated. Limited data account for the reasons behind this. The aim of the CEntralized Pan-European survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS) survey was to evaluate the current use and efficacy of lipid-lowering drugs (LLD), and to identify possible patient/physician characteristics associated with failure to achieve low-density lipoprotein cholesterol (LDL-C) targets recommended by the 2003 European guidelines (Third Joint Task Force). METHODS CEPHEUS was a European, multi-centre, cross-sectional survey conducted in eight countries and involved patients on LLD for >3 months (stable medication >6 weeks). One visit was scheduled for data collection, including fasting lipids. In all but one country, physicians and patients filled in a questionnaire about aspects of hypercholesterolaemia and treatment. RESULTS Of the 15 199 patients recruited, 14 478 were included in the final analyses. The mean age was 63.2 years, and 45% of patients were female. Overall, 55.3% of the patients achieved their LDL-C target. In multivariate analyses, the factors identified as positive predictors for achieving LDL-C goals included normal body mass index, not smoking, not having metabolic syndrome, being on statin therapy and good treatment adherence. LIMITATIONS The population was a selected group of subjects treated with LLD, and the results cannot be extrapolated to the general population. Patient consent was obtained, which may have selected more motivated patients and induced a positive bias. The physician and patient questionnaires were not validated, but were only used for exploratory purposes. CONCLUSION Only 55.3% of patients using LLD achieved the LDL-C target recommended in the 2003 European guidelines.
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Affiliation(s)
- Michel P Hermans
- Endocrinology and Nutrition Department, Université Catholique de Louvain, Avenue Hippocrate 54, B-1200 Woluwe-Saint-Lambert, Brussels, Belgium.
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Hotlines and clinical trial updates presented at the European Society of Cardiology Meeting 2009: data from RE-LY, PLATO, MADIT-CRT, PROTECT, SYNTAX, TRITON and more. Clin Res Cardiol 2009; 98:691-9. [DOI: 10.1007/s00392-009-0085-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/14/2009] [Indexed: 11/26/2022]
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Iijima R, Byrne RA, Dibra A, Ndrepepa G, Spaulding C, Laarman GJ, Menichelli M, Valgimigli M, Di Lorenzo E, Kaiser C, Tierala I, Mehilli J, Suttorp MJ, Violini R, Schömig A, Kastrati A. Drug-eluting stents versus bare-metal stents in diabetic patients with ST-segment elevation acute myocardial infarction: a pooled analysis of individual patient data from seven randomized trials. Rev Esp Cardiol 2009; 62:354-64. [PMID: 19401120 DOI: 10.1016/s1885-5857(09)71662-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The performance of drug-eluting stents (DESs) in high-risk patients with diabetes and acute ST-elevation myocardial infarction (STEMI) who have undergone primary angioplasty has not been previously studied. The objective was to evaluate the efficacy and safety of DESs in diabetic patients with STEMI. METHODS We performed a pooled analysis of individual patient data from seven randomized trials that compared DESs (i.e., sirolimus- or paclitaxel-eluting stents) with bare-metal stents (BMSs) in patients with STEMI. The analysis involved 389 patients with diabetes mellitus from a total of 2476 patients. The outcomes of interest were target-lesion revascularization, stent thrombosis, death and the composite endpoint of death or recurrent myocardial infarction during a follow-up of 12-24 months. RESULTS Overall, 206 diabetic patients received a DES and 183, a BMS. The risk of target-lesion revascularization was significantly lower in patients treated with a DES compared to those treated with a BMS (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.23-0.88; P=.02). There was no significant difference in the risk of stent thrombosis between those treated with a DES or a BMS (HR 0.33, 95% CI 0.09-1.13; P=.08). Similarly, the risk of the combined endpoint of death or myocardial infarction was not significantly different between patients treated with a DES or a BMS (HR 0.64, 95% CI 0.36-1.13; P=.12). CONCLUSIONS Compared with BMSs, DES use improved clinical outcomes in diabetic patients undergoing primary angioplasty for STEMI: the need for reintervention was reduced, with no increase in mortality or myocardial infarction.
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Affiliation(s)
- Raisuke Iijima
- Deutsches Herzzentrum, Technische Universität, Lazarettstr 36, Múnich 80636, Alemania.
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Volpe M, Tocci G, Avogaro A, Comaschi M, Corsini A, Cortese C, Giorda CB, Guida P, Medea G, Mureddu GF, Titta G, Ventriglia G, Zito GB, Manzato E. Global Cardiovascular Risk Assessment in Different Clinical Settings. High Blood Press Cardiovasc Prev 2009. [DOI: 10.2165/00151642-200916020-00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hatzitolios A, Athyros V, Karagiannis A, Savopoulos C, Charalambous C, Kyriakidis G, Milidis T, Papathanakis C, Bitli A, Vogiatsis I, Ntaios G, Katsiki N, Symeonidis A, Tziomalos K, Mikhailidis D. Implementation of strategy for the management of overt dyslipidemia: The IMPROVE-dyslipidemia study. Int J Cardiol 2009; 134:322-9. [DOI: 10.1016/j.ijcard.2009.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 11/21/2008] [Accepted: 02/06/2009] [Indexed: 11/15/2022]
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Iijima R, Byrne RA, Dibra A, Ndrepepa G, Spaulding C, Laarman GJ, Menichelli M, Valgimigli M, Di Lorenzo E, Kaiser C, Tierala I, Mehilli J, Suttorp MJ, Violini R, Schömig A, Kastrati A. Stents liberadores de fármacos frente a stents convencionales en pacientes diabéticos con infarto agudo de miocardio con elevación del segmento ST: un análisis combinado de los datos de pacientes individuales de 7 ensayos aleatorizados. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70892-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farnier M, Averna M, Missault L, Vaverkova H, Viigimaa M, Massaad R, Vandormael K, Johnson-Levonas AO, Brudi P. Lipid-altering efficacy of ezetimibe/simvastatin 10/20 mg compared with rosuvastatin 10 mg in high-risk hypercholesterolaemic patients inadequately controlled with prior statin monotherapy - The IN-CROSS study. Int J Clin Pract 2009; 63:547-59. [PMID: 19222610 DOI: 10.1111/j.1742-1241.2009.02022.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To evaluate the efficacy of switching from a previous statin monotherapy to ezetimibe/simvastatin (EZE/SIMVA) 10/20 mg vs. rosuvastatin (ROSUVA) 10 mg. METHODS In this randomised, double-blind study, 618 patients with documented hypercholesterolaemia [low-density lipoprotein cholesterol (LDL-C) > or = 2.59 and < or = 4.92 mmol/l] and with high cardiovascular risk who were taking a stable daily dose of one of several statin medications for > or = 6 weeks prior to the study randomisation visit entered a 6-week open-label stabilisation/screening period during which they continued to receive their prestudy statin dose. Following stratification by study site and statin dose/potency, patients were randomised to EZE/SIMVA 10/20 mg (n = 314) or ROSUVA 10 mg (n = 304) for 6 weeks. RESULTS EZE/SIMVA produced greater reductions in LDL-C (-27.7% vs. -16.9%; p < or = 0.001), total cholesterol (-17.5% vs. -10.3%; p < or = 0.001), non-high-density lipoprotein cholesterol (HDL-C) (-23.4% vs. -14.0%; p < or = 0.001) and apolipoprotein B (-17.9% vs. -9.8%; p < or = 0.001) compared with ROSUVA, while both treatments were equally effective at increasing HDL-C (2.1% vs. 3.0%; p = 0.433). More patients achieved LDL-C levels < 2.59 mmol/l (73% vs. 56%), < 2.00 mmol/l (38% vs. 19%) and < 1.81 mmol/l (25% vs. 11%) with EZE/SIMVA than ROSUVA (p < or = 0.001). A borderline significantly greater reduction in triglycerides (p = 0.056) was observed for EZE/SIMVA (-11.0%) vs. ROSUVA (-5.3%). There were no between-group differences in the incidences of adverse events or liver transaminase and creatine kinase elevations. CONCLUSION EZE/SIMVA 10/20 mg produced greater improvements in LDL-C, total cholesterol, non-HDL-C and apoB with a similar safety profile as for ROSUVA 10 mg.
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Affiliation(s)
- M Farnier
- Point Medical, Rond Point de Nation, Dijon, France.
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Berdah J, Amah G. [Differences between women and men: even through cardiovascular risk factors... role of the gynecologist]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2009; 37:186-193. [PMID: 19211291 DOI: 10.1016/j.gyobfe.2008.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 12/16/2008] [Indexed: 05/27/2023]
Affiliation(s)
- J Berdah
- Service d'endocrinologie et de médecine de la reproduction, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Effect of secondary prevention on all-cause mortality in Czech survivors of myocardial infarction: a population-based study. COR ET VASA 2009. [DOI: 10.33678/cor.2009.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Koeth O, Bauer T, Wienbergen H, Gitt AK, Juenger C, Zeymer U, Hauptmann KE, Glunz HG, Sechtem U, Senges J, Zahn R. Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry. Clin Res Cardiol 2008; 98:107-13. [PMID: 18982378 DOI: 10.1007/s00392-008-0730-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice. METHODS We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry. RESULTS Out of a total of 34276 patients with STEMI, 10600 (30.9%) were treated with intravenous thrombolysis. Out of these patients, 487 (4.6%) patients received an angioplasty between 61 min and 24 hours after thrombolysis. They were compared to 10113 (95.4%) patients who received PCI either later than 24 hours after thrombolysis or not at all. A continuous increase in the frequency of early PCI between the years 1994 (2%)-2002 (16.7%) was observed. After adjusting for confounding variables independent predictors to use early PCI were the increasing year of inclusion, the facility of the hospital to perform PCI, younger age and male gender. Hospital mortality was 7.2% in patients receiving early PCI, compared to 11.2% in the other group (<0.01). Independent predictors for a higher hospital mortality were shock, age >65 years, female gender, an anterior STEMI and a prehospital delay of >3 hours. However, early PCI was not longer associated with a lower mortality (OR 0.95, 95% CI 0.64-1.14). CONCLUSION Early PCI after thrombolysis is used infrequently in current clinical practice in Germany. Especially 'low risk' patients were treated with an early PCI, which may contribute to the missing effect on mortality compared to no or late PCI after thrombolysis.
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Affiliation(s)
- Oliver Koeth
- Department of Cardiology, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen am Rhein, Germany.
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Liberopoulos EN, Florentin M, Mikhailidis DP, Elisaf MS. Compliance with lipid-lowering therapy and its impact on cardiovascular morbidity and mortality. Expert Opin Drug Saf 2008; 7:717-25. [DOI: 10.1517/14740330802396984] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thomas D, Giugliano RP. ExTRACT-TIMI 25 in perspective: key lessons regarding enoxaparin as an adjunct to fibrinolytic therapy. J Thromb Thrombolysis 2008; 27:1-10. [DOI: 10.1007/s11239-008-0284-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/25/2008] [Indexed: 11/25/2022]
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Windak A, Gryglewska B, Tomasik T, Narkiewicz K, Grodzicki T. Competence of General Practitioners in Giving Advice about Changes in Lifestyle to Hypertensive Patients. Med Decis Making 2008; 29:217-23. [DOI: 10.1177/0272989x08324956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective . The aim of this study was to assess the advice about lifestyle changes that general practitioners (GPs) gave hypertensive patients with different levels of cardiovascular risk. Design and Methods . A stratified sample of primary health care physicians in Poland completed a questionnaire consisting of 8 case vignettes that differed with regard to 3 major variables: 1) the level of blood pressure (high-normal blood pressure or grade 2 hypertension), 2) the presence of selected risk factors such as smoking and obesity, and 3) diabetes mellitus. The case vignettes were followed by a series of open questions. Results . The response rate was 65% (125/192 selected physicians responded). The mean age was 45.2 ± 8.1 years, and the average length of professional experience in primary care was 14.7 ± 9.3 years. For 1000 potential clinical decisions considered, all expected pieces of advice were given in 18.3% of situations, whereas in 11.5%, no advice concerning nonpharmacological treatment was provided. In 70.2% of situations, Polish primary health physicians gave incomplete advice. The average percentage of expected advice in all cases was 57.2% ± 30.8%. The presence of hypertension along with other risk factors of cardiovascular disease was associated with better quality advice (P < 0.001), but the coexistence of diabetes mellitus had opposite consequences (P< 0.001). Conclusions . Despite the existence of well-known guidelines for the treatment of hypertension in Poland, GPs rarely give complete lifestyle advice, particularly for patients with cardiovascular risk due to high-normal blood pressure and diabetes.
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Affiliation(s)
- Adam Windak
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland,
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tomasik
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Modern management of acute myocardial infarction is built on a clinical evidence base drawn from many studies undertaken over the past three decades. The evolution in clinical practice has substantially reduced mortality and morbidity associated with the condition. Key to this success is the effective integration of antithrombotic therapy combined with timely reperfusion, either primary percutaneous coronary intervention or fibrinolysis for ST-elevation myocardial infarction, and invasive investigation and revascularisation for non-ST-elevation myocardial infarction, underpinned by risk stratification and optimised systems of care. After the development of troponin assays for the detection of myonecrosis, the universal definition and classification of myocardial infarction now indicates the underlying pathophysiology. Additionally, an increasing appreciation of the importance of adverse events, such as bleeding, has emerged. Remaining challenges include the effective translation of this evidence to all patients with myocardial infarction, especially to those not well represented in clinical trials who remain at increased risk of adverse events, such as elderly patients and those with renal failure. On a global level, the epidemic of diabetes and obesity in the developed world and the transition from infectious diseases to cardiovascular disease in the developing world will place an increasing demand on health-care infrastructures required to deliver time-dependent and resource-intensive care. This Seminar discusses the underlying pathophysiology, evolving perspectives on diagnosis, risk stratification, and the invasive and pharmacological management of myocardial infarction.
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Affiliation(s)
- Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Roe MT, Kikano G, Miller CD, Hoekstra JW. Continuum of care in the treatment of ST-segment elevation myocardial infarction (STEMI): importance of platelet and coagulation inhibition. Postgrad Med 2008; 120:67-78. [PMID: 18654071 DOI: 10.3810/pgm.2008.07.1793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) is a serious manifestation of atherothrombosis. Platelets play an important role in the pathogenesis of atherothrombosis, and the use of antiplatelet agents is associated with substantial improvements in clinical outcome. Current guidelines for the management of patients with STEMI stress the importance of using antiplatelet agents as an integral part of acute and long-term therapy. However, these and other recommended therapies are frequently underutilized. In-hospital quality improvement initiatives have been shown to substantially improve adherence to guideline-recommended therapies at the time of discharge. This review discusses the role of platelets in atherothrombosis and describes the medical management of patients with STEMI, highlighting current guideline recommendations, adherence in clinical practice, and the impact of quality improvement programs in maintaining the continuum of care into the ambulatory setting.
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Affiliation(s)
- Matthew T Roe
- Division of Cardiovascular Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 27710, USA.
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Tomaske M, Breithardt OA, Balmer C, Bauersfeld U. Successful cardiac resynchronization with single-site left ventricular pacing in children. Int J Cardiol 2008; 136:136-43. [PMID: 18620766 DOI: 10.1016/j.ijcard.2008.04.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 04/06/2008] [Accepted: 04/23/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dyssynchronous left ventricular (LV) contraction due to permanent right ventricular apex (RVA) pacing or delayed electrical activation as typically observed in left bundle brunch block (LBBB) has a negative impact on LV function. Objective was to evaluate the impact of epicardial single-site LV pacing in children on LV function and resynchronization. PATIENTS Single-site epicardial LV free wall pacing was established in 6 children with congenital heart disease and echocardiographic signs of LV dyssynchrony. Reasons for dyssynchrony were either long-term RVA pacing (n=5; pacing duration: 7.7+/-2.4 years) or LBBB with drug-resistant congestive heart failure (n=1). RESULTS After 1 month of single-site LV pacing, LV ejection fraction increased (41+/-6 versus 53+/-8%) and LV enddiastolic volume decreased (70+/-22 versus 63+/-18 ml/m(2)) as compared to pre-implant measurements. Interventricular mechanical delay decreased (67+/-15 versus 16+/-15 ms) and intraventricular synchrony was restored (septal-to-posterior wall motion delay: 312+/-24 versus 95+/-57 ms). Accordingly, circumferential 2D strain demonstrated a decrease of LV mechanical delay (201+/-35 versus 99+/-23 ms). CONCLUSION After 1 month of single-site LV pacing, conventional and 2D strain derived echocardiographic measurements indicated improved ventricular function and synchronization in children with previous RVA pacing or LBBB. Further studies are needed to evaluate whether single-site LV pacing may be sufficient for resynchronization therapy.
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Affiliation(s)
- Maren Tomaske
- Division of Paediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
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The Association of Peripheral Arterial Occlusive Disease with Major Coronary Events in a Mediterranean Population with Low Coronary Heart Disease Incidence. Eur J Vasc Endovasc Surg 2008; 36:71-6. [DOI: 10.1016/j.ejvs.2008.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 01/15/2008] [Indexed: 11/22/2022]
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Werner CM, Böhm M. Review: The therapeutic role of RAS blockade in chronic heart failure. Ther Adv Cardiovasc Dis 2008; 2:167-77. [DOI: 10.1177/1753944708091777] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease represents a continuum that starts with risk factors such as hypertension and progresses to atherosclerosis, end-organ damage, and ultimately to chronic heart failure (CHF) and premature death. Renin-angiotensin system (RAS) blockade with angiotensin converting enzyme (ACE) inhibitors and/or angiotensin II type 1 receptor blockers (ARBs) has turned out to be beneficial at all stages of this continuum. Several mechanisms govern the progression of structural myocardial damage to end-stage CHF. Chronic neuroendocrine activation fosters left ventricular remodeling and dilatation and leads to clinical symptoms of CHF via forward/backward failure. RAS inhibition is a cornerstone of neuroendocrine blockade in CHF patients, and combined RAS blockade is especially effective in patients presenting with repetitive cardiac decompensations. This review focuses on the therapeutic role of inhibitors of different RAS components in chronic heart failure caused by systolic left ventricular dysfunction.
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Affiliation(s)
- Christian M. Werner
- Kardiologische Forschung Kardiologie, Angiologie und Internistische Intensivmedizin Innere Medizin - Universitätsklinikum des Saarlandes Kirrberger Str. D-66421 Homburg,
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Ferri C, Croce G, Desideri G. Role of combination therapy in the treatment of hypertension: focus on valsartan plus amlodipine. Adv Ther 2008; 25:300-20. [PMID: 18449492 DOI: 10.1007/s12325-008-0042-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension control is rare in clinical practice, particularly in high-risk patients. A large factor is therapeutic inertia deriving from poorly prescribed lifestyle changes, excess monotherapy use, and scarce on-treatment modifications. The use of drug combinations significantly improves blood pressure (BP) control; in particular, fixed combinations improve therapy without increasing daily pill intake, thereby favouring patient compliance and therapy continuation. The most widely used fixed combination is based on thiazide diuretics added to either angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). Several large-scale clinical trials have been conducted showing that these combinations are effective in lowering BP. However, thiazide diuretics can reduce the metabolic benefits derived from renin-angiotensin-aldosterone system (RAAS) inhibitors in high metabolic risk patients. In contrast, ACE inhibitors or ARBs combined with dihydropyridine calcium channel antagonists (DHPCAs) exert a marked antihypertensive effect without decreasing metabolic protection by RAAS blockade. In the recent JIKEI heart study, approximately 60% of patients affected by hypertension, heart failure, coronary heart disease or their combination in the valsartan arm were simultaneously treated with DHPCAs. Of note, a 39% reduction in the primary endpoint of combined morbidity and mortality was reported in the valsartan compared with the non-valsartan arm. Furthermore, in a recent multinational study, 83% of 3161 hypertensive patients treated with valsartan and the DHCPA amlodipine reported a concontrolled BP after 8 weeks of treatment. As expected, amlodipine did not negatively influence the metabolic profile of patients, thereby supporting the role of ARB+DHPCA combinations as effective and promising tools in hypertension treatment. In summary, the combination of ARBs with DHPCAs is an effective strategy in hypertension treatment through synergy between their antihypertensive and vascular protective actions, persistent metabolic benefits deriving from RAAS inhibition, and reduced incidence of side effects.
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Affiliation(s)
- Claudio Ferri
- Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy.
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Alfonso F, Segovia J, Heras M, Bermejo J. Prevención cardiovascular: ¿siempre demasiado tarde? Rev Esp Cardiol 2008. [DOI: 10.1157/13116657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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