Rede AMICOR chega aos 10 anos

Aloyzio Achutti (coordenador)A rede AMICOR foi criada com uma mensagem enviada a um grupo de colegas no dia 17 de maio de 1997. Uma semana depois da conclusão do Primeiro Seminário Nacional de Epidemiologia e Prevenção das Doenças Cardiovasculares circulou a primeira mensagem entre 23 (dos mais de 50) que haviam participado do evento e que dispunham de correio eletrônico. Hoje são mais de 300 - a maioria composta de brasileiros e cardiologistas.
O propósito inicial era de circular o texto gerado durante o encontro da Declaração de Gramado, para chegar à sua versão final, que pode ser lida ainda hoje no seguinte endereço: http://www.procor.org/story.asp?section=S125&sitecode=procor&storyid=
Web611137234procor1217021180&pn=1&parentsec=S124
A experiência tornou evidente a facilidade com que era possível também repassar para uma lista de endereços as referências e artigos tidos como relevantes para serem guardados para uso próprio. A visitação das páginas, e a inscrição para participar da lista foram sempre gratuitas; e a atividade de coordenação iniciativa pessoal espontânea, sem contar com nenhum subsídio ou gratificação a não ser a satisfação dos colegas e a percepção de que a atividade estava sendo útil para a comunidade.
As mensagens começavam com a saudação “caros amigos do coração”, até que um deles, Eduardo de Azeredo Costa, sugeriu utilizar o nome Amicor, tornando-se então o padrinho da rede.
Em julho do mesmo ano, durante a Conferência Internacional de Cardiologia Preventiva realizada em Montreal, o Professor Bernard Lown (Boston. Prêmio Nobel de 1985), lançou o projeto ProCOR, visando também uma rede eletrônica de discussão, cobrindo países em desenvolvimento. Posteriormente, tomando conhecimento da rede AMICOR, convidou-me para colaborar compondo o Conselho Internacional do ProCOR, e para utilizar o nome AMICOR em iniciativas semelhantes de outras regiões. Assim se formaram outras redes AMICOR: Índia, Paquistão, Argentina, Guatemala, e Líbano, com perspectivas em outros países.
Inicialmente a comunicação se resumia na troca de e-mails com referências ou artigos inteiros, mas logo surgiram problemas com o correio eletrônico (vírus, mensagens indesejadas, etc...) que motivaram a busca de outro método de comunicação.
Um servidor próprio foi instalado em casa com acesso aberto a uma página quase que diariamente atualizada, e uma mensagem de alerta enviada para os membros da lista.
O surgimento dos Blogs veio facilitar a publicação e a manutenção da comunicação em rede, sempre com o envio de mensagens de alerta, permitindo a desativação do servidor dedicado.
Parte das referências enviadas aos membros da lista, foram durante bastante tempo aproveitadas pela Sociedade Brasileira de Cardiologia que manteve uma secção chamada AMIFUNCOR em seu endereço no setor de educação continuada, promovendo simultaneamente o endereço do ProCOR. O desenvolvimento do Portal SBC, com suas múltiplas oportunidades de atualização científica, tornou desnecessária esta inclusão que passa a ser apenas uma das referências (link) interessantes.
Também ProCOR ficou mais dinâmico e se desenvolveu muito em número de membros afiliados, em participação e em organização de conteúdos, particularmente desde que assumiu sua posição a atual Editora-Chefe, Catherine Coleman. Este desenvolvimento nos leva a reconsiderar algumas atividades na AMICOR, buscando evitar cruzamento desnecessário de postagens.
Na medida em que novos participantes não cardiologistas se mostraram interessados em participar e foi aumentando a diversidade dos temas garimpados, os Blogs foram se diversificando. O básico e mais voltado para cardiologia permaneceu o http://amicor.blogspot.com/ contendo uma lista de endereços dos outros blogs e referências semelhantes no diretório principal.
Foi criado logo o http://amicor_preserve.blogspot.com/ para receber outros assuntos, não necessariamente médicos, mas de amplo interesse. Em seguida surgiu necessidade de criar o http://amicorsmoke.blogspot.com/ para acomodar os assuntos relacionados com tabagismo (hoje com múltiplos endereços confiáveis na grande rede mundial). O http://amicorpsy.blogspot.com/ surgiu para acomodar temas de interesse mais psiquiátricos. Um interesse especial pela determinação social e econômica da saúde e da doença e de um projeto co-patrocinado pela Iniciativa de Saúde Cardiovascular (IC-Health) deu origem ao http://amicorcvd.blogspot.com/ . Material e referências sobre formação, ética e valores da Medicina tem sido reunidos noutro endereço: http://amicor_medicina.blogspot.com/ .
O endereço http://achutti.blogspot.com/ mantém informações pessoais, atendendo também exigências da instituição HON “Health On the Net” que qualifica e credencia páginas que lidam com o tema saúde na Internet e que também certifica AMICOR.
Nos últimos três anos, através dos Blogs, foram postadas aproximadamente mil referências e enviadas mais de 200 mensagens de alerta – cada vez menos freqüentes devido à progressiva parcimônia recomendável atualmente para este tipo de comunicação. O número de mensagens enviadas ultrapassa a 2300 desde o início. O número total de referências enviadas não foi levantado, mas existe a disposição um CD com as mensagens enviadas; e desde a existência dos Blogs, todo o conteúdo está disponível, mês por mês ou acessível através de mecanismo de busca.
A possibilidade de se inscrever num endereço de agregação de informações e notificação automática (RSS) tipo http://bloglines.com/public/achutti tem sido sempre lembrada em cada mensagem, porém pouco usada. Este recurso possibilitaria evitar as mensagens de alerta por e-mail e receber automaticamente um anúncio de que novo material foi postado. Entretanto aqueles que têm respondido, dizem que preferem continuar recebendo mensagens semanais de alerta.
Quando foi criada a rede, imaginava-se que discussões de temas polêmicos, ou propostas de assuntos para discutir, se tornassem o ponto alto, o que, entretanto, não se verificou. Parece que o número de pessoas interessadas em discutir e participar ativamente de forma contínua é relativamente pequeno, o que é a regra em iniciativas coletivas.
É preciso levar em conta a diversidade de interesses focais, sua variação temporal num mesmo indivíduo e no momento histórico. O importante é a disponibilidade de um recurso confiável e a possibilidade de se sentir conectado, fazendo parte de uma comunidade, mesmo que virtual.
Entre as opções por onde evoluir a partir dos dez anos, estamos estudando a possibilidade de fomentar a discussão não somente a partir de escolha de um indivíduo, mas como continuidade da discussão de assuntos abordados em congressos e outras reuniões científicas. Isto poderia auxiliar na coleta de uma conclusão sumária ou questionamento adicional em nossos encontros, dando um tempo adicional “on line” para esclarecimento e difusão para um grupo maior de temas relevantes escolhidos não por um indivíduo isoladamente, mas sim, por um grupo de especialistas.
Outra idéia é de aproveitar tantas opções e redes semelhantes já existentes na INTERNET, evitando repetições e superposições, sonhando também com a construção de uma verdadeira rede de redes virtuais.
Este texto está em elaboração, aberto a contribuições, e se trata de uma provocação para ser completado ou melhorado.

Flu linked to heart disease deaths

Flu linked to heart disease deaths
Flu linked to heart disease deaths

18 April 2007

MedWire News: Influenza epidemics are associated with a rise in heart disease deaths, say researchers who advocate flu vaccination in patients at high risk for cardiovascular disease.

The international team found that winter peaks in acute respiratory deaths during influenza epidemics were associated with an increase in autopsy confirmed deaths due to myocardial infarction (MI) and chronic ischemic heart disease (IHD). They observed the effect in multiple years, so conclude that a rise in MI and IHD deaths may be anticipated during flu epidemics.

"This calls for more intensive efforts to increase the vaccination rate in people at risk of coronary heart disease, commented lead author Mohammad Madjid (University of Texas, Houston, USA). "This may be especially important in an influenza pandemic when we would expect to see high mortality amongst the elderly and those suffering from heart problems or who have multiple coronary risk factors."

Madjid and colleagues investigated deaths between 1993 and 2000 in St Petersburg, the Russian Federation, for which the documented cause of death on autopsy reports was coronary heart disease.

"Relying on autopsy reports rather than death certificates enabled us to be much more accurate about the cause of death, because doctors often neglect to list flu on a death certificate if their patients have died from a heart attack and, conversely, heart attack symptoms can be missed in patients suffering from flu and pneumonia," Madjid explained.

The results showed that 11,892 people died from acute MI and 23,000 died from IHD. The risk of dying from acute MI increased by one third, and the chance of dying from IHD by one tenth, during epidemic weeks relative to non-epidemic weeks. The effect was seen in both genders and across all age groups.

The researchers believe that acute inflammation in flu can destabilize atherosclerotic plaques causing consequent thrombotic events.

"My public health message is that flu is an important killer in cardiac patients," said Madjid. "If people can recognize that the flu vaccine has specific cardioprotective effects, then high-risk people will be more likely to make sure that they receive the influenza vaccine every year."

He estimates that up to 90,000 coronary deaths a year could be prevented in the USA if every high-risk patient received an annual flu vaccination.

He urged the European Society of Cardiology to follow the lead set in the USA by the American Heart Association and American College of Cardiology and recommend that all at-risk people should be given flu vaccines.

"The vaccine may be even more beneficial for those from deprived socio-economic groups or under-developed countries who are not taking all the recommended cardioprotective medications due to their high cost or lack of access to proper medical care," Madjid added. "The flu vaccine is inexpensive, easy to administer, and could save thousands of lives every year."

He stressed that cardiovascular deaths have surpassed any other causes of mortality, including pneumonia, in most influenza epidemics (except for the 1918 Spanish flu pandemic). Thus, during influenza pandemics, heart disease patients should be considered among priority groups to receive the vaccine or antiviral drugs.

Madjid noted that stockpiling of antivirals such as Tamiflu and progress in developing specific avian flu vaccines should provide sufficient means to combat the next pandemic, provided "nature doesn't take us by surprise this year."

Eur Heart J; 2007; Advance online publication

Open Medicine

Open Medicine
Open Medicine
The mission of Open Medicine is to facilitate the equitable dissemination of high-quality health research; to promote international dialogue and collaboration on health issues; to improve clinical practice; and to expand and deepen the understanding of health and health care.
The Journal will examine issues relevant to health and clinical medicine both in Canada and internationally.

Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever,

Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group -- Wilson et al., 10.1161/CIRCULATIONAHA.106.183095 -- Circulation: "Background--The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997.

Methods and Results--A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocardit"

Effect of Torcetrapib on the Progression of Coronary Atherosclerosis

Effect of Torcetrapib on the Progression of Coronary Atherosclerosis: "Study Question: Does torcetrapib, a novel cholesteryl ester transfer protein (CETP) inhibitor that raises high-density lipoprotein cholesterol (HDL-C) by more than 50%, impact progression of coronary atherosclerosis?
Methods: A total of 1,188 patients with coronary disease underwent intravascular ultrasonography (IVUS). After treatment with atorvastatin to reduce levels of low-density lipoprotein cholesterol (LDL-C) to <100 mg/dl (2.59 mmol/L), patients were randomly assigned to receive either atorvastatin monotherapy or atorvastatin plus 60 mg of torcetrapib daily. After 24 months, disease progression was measured by repeated IVUS in 910 patients (77%). Each target site for the primary analysis was required to have <50% obstruction throughout a segment of 40 mm or longer.
Results: Mean age was 57 years, 70% were men, and 91% were on a statin at baseline. Baseline mean LDL-C was 84 mg/dl and HDL-C was 45.5 mg/dl, and median LDL-C:HDL-C was 1.89. After 24 months, as compared with atorvastatin monotherapy, the effect of torcetrapib�atorvastatin therapy was an approximate 61% relative increase in HDL-C (43.9 mg/dl vs. 72.1 mg/dl) and a 20% relative decrease in LDL-C, reaching a ratio of LDL-C to HDL-C of <1.0. Torcetrapib was also associated with an increase in systolic blood pressure of 4.6 mm Hg. The percent atheroma"

Research into raising HDL cholesterol presses on despite setbacks

Research into raising HDL cholesterol presses on despite setbacks
Many still view this strategy as offering the best chance for the next big breakthrough in cardiovascular health.
By Victoria Stagg Elliott, AMNews staff. April 16, 2007.
Filling in the blanks regarding the fall of torcetrapib, the once-promising cardiovascular drug for which Pfizer Inc. pulled the clinical trials plug in December 2006, has become a hot topic in the ongoing pursuit of a new and better way to address cholesterol problems.
For instance, new research indicates that the drug raised high-density lipoprotein cholesterol but did not impact coronary atherosclerosis. This finding is most likely because it did not create well-functioning cholesterol molecules, according to a pair of studies presented at the American College of Cardiology meeting in New Orleans and published last month in the New England Journal of Medicine.
"Our findings demonstrate the great difficulty in developing therapies to interrupt the atherosclerosis process," said Steven Nissen, MD, one of the study's lead authors and ACC's immediate past president.
Pfizer ended research into this drug because of an increased rate of cardiovascular events and deaths among study participants who took it. But although this recent round of data confirms that the drug didn't work and also provides some insight into why, those involved say there are still many questions that need answering. Much work also is needed if a drug is to be developed that does safely raise HDL -- the strategy many view as most likely to produce the next big cardiovascular health breakthrough.
"It's been about 20 years since the statin drugs were introduced," said Dr. Nissen, who is also chair of Cleveland Clinic's Cardiovascular Medicine Dept. "Statins are great, but we need more. We have to figure out how to raise HDL."

Zelnorm (tegaserod maleate) Information

Zelnorm (tegaserod maleate) Information: "Zelnorm (tegaserod maleate) Information
FDA is announcing that Novartis Pharmaceuticals has agreed to FDA’s request that they voluntarily discontinue marketing and sales of Zelnorm (tegaserod maleate). FDA’s request was based on newly available information of an increased risk of serious cardiovascular adverse events, including myocardial infarction (heart attack), unstable angina (chest pain), and stroke, associated with use of the drug. Based on this new information, FDA has concluded that the overall risk versus benefit profile for the drug is unfavorable for continued marketing. "

CDC

The Centers for Disease Control and Prevention (or CDC) is an agency of the U.S. Department of Health and Human Services based in Atlanta, Georgia. Recognized as the leading United States government agency for protecting the public health and safety of people, the CDC provides credible information to enhance health decisions and promotes health through strong partnerships with state health departments and other organizations. The CDC focuses national attention on developing and applying disease prevention and control (especially infectious diseases), environmental health, health promotion and education activities designed to improve the health of the people of the United States.

Economia da Cirurgia Cardiovascular no BR - ABC

Custo hospitalar da cirurgia de revascularização miocárdica O objetivo do estudo foi avaliar os custos hospitalares da cirurgia de revascularização miocárdica em pacientes coronarianos eletivos. O procedimento realizado em 103 pacientes, em 2005, teve custo médio de R$ 6.990,30, variando de R$ 5.438,69 a R$ 11.778,96. O custo médio para três a cinco pontes (R$ 7.148,05) foi maior do que para uma ou duas pontes (R$ 6.659,29). Impacto do stent farmacológico no orçamento do Sistema Único de Saúde Foi elaborado um modelo para prever o impacto econômico da incorporação de stents farmacológicos no orçamento do SUS. Os resultados do primeiro ano indicam que a implementação do stent farmacológico pelo SUS provocaria um aumento de despesas de 12,8%, no cenário conservador, e de 24,4%, no pior cenário, representando aumentos de R$ 24 milhões a R$ 44 milhões no orçamento total projetado. Custo efetividade dos stents recobertos por rapamicina no Brasil A sobrevida em um ano livre de reestenose foi de 92,7% com o stent revestido e de 78,8% com o stent convencional. Da perspectiva do SUS, o custo por evento evitado, em um ano, foi de R$ 47.529,00. A relação de custo-efetividade do stent revestido por rapamicina foi elevada no modelo brasileiro. O stent revestido torna-se mais favorável em pacientes de alto risco de reestenose.

Coffee By the Bucket Better for Blood Pressure than By the Cup - CME Teaching Brief® - MedPage Today

Coffee By the Bucket Better for Blood Pressure than By the Cup - CME Teaching Brief® - MedPage Today: "Women who drink coffee by the pot full for a long time had a lower relative risk of hypertension than did women who indulged in one to three daily cups, Cuno S.P.M. Uiterwaal, M.D., of the University Medical Center, Utrecht, and colleagues, reported in the March issue of the American Journal of Clinical Nutrition. "

Novel Anticoagulant May Sidestep Bleeding Risk - CME Teaching Brief® - MedPage Today

ACC: Novel Anticoagulant May Sidestep Bleeding Risk - CME Teaching Brief® - MedPage Today: "NEW ORLEANS, March 25 -- An investigational oral thrombin receptor antagonist led to a trend toward reduced fatal and non-fatal cardiac events, with a low bleeding risk, in a phase II trial of patients with percutaneous coronary interventions, mostly stenting.

In the early results on the safety of SCH 530348, the first oral thrombin receptor antagonist, there was a slight but not statistically significant increase in major and minor bleeding events -- 4% versus 3.3% for placebo -- with a 40-mg dose. In further trials, 40 mg is the investigational dose that is expected to be pursued."

Dark Chocolate Improves Vascular Function - CME Teaching Brief® - MedPage Today

ACC: Dark Chocolate Improves Vascular Function - CME Teaching Brief® - MedPage Today: "EW ORLEANS, March 25 -- A cup of cocoa in the morning may improve endothelial function for overweight patients, a small study confirmed, particularly if the dark chocolate powder is mixed with unsweetened water. "

Clinical Characteristics andUtilization of Biochemical Markers in Acute Coronary Syndromes

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.182882v1

Acute coronary syndrome (ACS)8 refers to a constellation of clinical symptoms caused by acute myocardial ischemia1,2. Owing to their higher risk for cardiac death or ischemic complications, patients with ACS must be identified among the estimated 8 million patients with nontraumatic
chest symptoms presenting for emergency evaluation each year in the US3. In practice, the terms suspected or possible ACS are often used by medical personnel early in the process of evaluation to describe patients for whom the symptom complex is consistent with ACS but the diagnosis has not yet been conclusively established./.../

Analytical Issues for Biochemical Markers of Acute Coronary Syndromes

Acute Coronary Syndromes and Heart Failure

High-Risk Lipid Abnormalities in Children and Adolescents. A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, Wi

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents. A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, Wi: "High-Risk Lipid Abnormalities in Children and Adolescents"
Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents.

Abstract--Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy

Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update

Worldwide, cardiovascular disease (CVD) is the largest single cause of death among women, accounting for one third of all deaths.¹ In many countries, including the United States, more women than men die every year of CVD, a fact largely unknown by physicians.^2,3 The public health impact of CVD in women is not related solely to the mortality rate, given that advances in science and medicine allow many women to survive heart disease. For example, in the United States, 38.2 million women (34%) are living with CVD, and the population at risk is even larger.² In China, a country with a population of approximately 1.3 billion, the age-standardized prevalence rates of dyslipidemia and hypertension in women 35 to 74 years of age are 53% and 25%, respectively, which underscores the enormity of CVD as a global health issue and the need for prevention of risk factors in the first place.⁴ As life expectancy continues to increase and economies become more industrialized, the burden of CVD on women and the global economy will continue to increase.⁵ The human toll and economic impact of CVD are difficult to overstate. In the United States alone, $403 billion was estimated to be spent in 2006 on health care or in lost productivity as a result of CVD, compared with $190 billion for cancer and $29 billion for human immunodeficiency virus (HIV).² In addition to population-based and macroeconomic interventions, interventions in individual patients are key to reducing the incidence of CVD globally.⁶ Prevention of CVD is paramount to the health of every woman and every nation. Even modest control could have an enormous impact. It is projected that a reduction in the death rate due to chronic diseases by just 2% over 1 decade would prevent 36 million deaths.⁶

Statin use and risk of 10 Cancers

[Original Article]
Coogan, Patricia F.*; Rosenberg, Lynn*; Strom, Brian L.†‡
From the *Slone Epidemiology Center, Boston University, Boston, Massachusetts; †Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Center for Education and Research on Therapeutics, and ‡Division of General Internal Medicine of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Submitted 16 May 2006; accepted 13 November 2006.
Supported by grant R01 CA45762 from the National Cancer Institute.
Editors’ note: A commentary on this article appears on page 194.
Correspondence: Patricia F. Coogan, Slone Epidemiology Center, 1010 Commonwealth Ave., Boston, MA 02215. E-mail: pcoogan@bu.edu
Abstract
Background: Statins affect the proliferation, survival, and migration of cancer cells, and it is thought that they may have chemopreventive properties in humans. The purpose of the present study was to evaluate the association between statin use and various types of cancer in our hospital-based case–control surveillance study.
Methods: Data were collected from patients ages 40–79 years who were admitted to participating hospitals in 3 centers in Philadelphia, New York, and Baltimore from 1991 to 2005. Nurses administered questionnaires to obtain information on medication use and other factors. We compared patients who had any of 10 types of cancer (a total of 4913 patients) with controls admitted for noncancer diagnoses (3900 patients). The following cancers were examined individually: female breast (n = 1185), prostate (n = 1226), colorectal (n = 734), lung (n = 464), bladder (n = 240), leukemia (n = 254), pancreas (n = 220), kidney (n = 226), endometrial (n = 220), and non-Hodgkin lymphoma (n = 144). Logistic regression models were used to estimate odds ratios and 95% confidence intervals among regular statin users compared with never-users.
Results: Odds ratios were compatible with 1.0 for all cancer types. For the 4 largest cancer sites (breast, prostate, colorectum, and lung), odds ratios did not vary significantly by duration of statin use.
Conclusions: Statins are among the most commonly used medications, and durations of use are increasing. The present data do not support either positive or negative associations between statin use and the occurrence of 10 cancer types. Cancer incidence should continue to be monitored among statin users.

guidelines for cardiovascular disease prevention in women

De: Marcelo Colominas [mailto:mgcolominas@gigared.com]
Enviada em: terça-feira, 6 de março de 2007 13:15
Para: Undisclosed-Recipient:;
Assunto: Revisión (AHA) de guías de prevención CV en la mujer

Review of the American Heart Association’s guidelines for cardiovascular disease prevention in women

J H Mieres

Correspondence to:
Jennifer H Mieres
MD, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA; jmieres@nshs.edu

Cardiovascular disease (CVD) is the leading cause of death of women in the United States and most of the developed world. The latest available data from the World Health Organization indicate that 16.6 million people around the globe die of CVD each year. World deaths from coronary heart disease (CHD) in 2002 totalled 7.2 million. One in seven women in Europe will die of CHD; in the United Kingdom > 1.2 million women are living with CHD. Despite advances in diagnosing and treating CHD, the disease accounts for the majority of CVD deaths in women in the United States, with more than 240 000 dying annually. Although coronary heart disease is the predominant cause of mortality for adult women in the United States, screening for coronary risk factors and coronary risk reduction interventions remains underused in women. In February of 2004, the American Heart Association published the first evidence-based guidelines for CVD prevention in women, consisting of a set of clinical recommendations tailored to a woman’s individual level of risk.

Risco Cardiometabólico

Caro amigo: publiquei no site da SBD http://www.diabetes.org.br/ a matéria abaixo:

Risco Cardiometabólico: Uma Visão que Integra Endocrinologistas e Cardiologistas Reginaldo Albuquerque - 02/03/2007 13:21 editor científico do site da SBDMédicos endocrinologistas e cardiologistas estão começando a entender melhor as importantes conexões entre as doenças cardiovasculares e o diabetes. Isto se deve às descobertas de novos mecanismos fisiopatológicos que estão presentes nas duas situações, tais como as lesões no endotélio dos vasos. Estas lterações são decorrentes do "stress oxidativo", da obesidade, da má alimentação, da ipertensão arterial e até mesmo de infecções provenientes de lesões dentárias. Esta nova compreensão levou à criação de um novo conceito denominado "Risco Cardiometabólico". Risco cardiometabólico diz respeito a um conjunto de causas que representam potenciais fatores de risco que são alvos potenciais para um tratamento preventivo. A despeito de muitos avanços na prevenção e tratamento das doenças cardiovasculares (DCV), elas continuam como a principal causa de morte em muitos países desenvolvidos. De acordo com o estudo Hational Health and Nutrition Examination Survey (NHANES), realizado entre 1999-2002, 972.000 americanos morreram de doenças relacionadas com DCV em 2002.Acredita-se que neste estudo 224000 mortes foram causadas por diabetes do tipo 2. O NHANES 1999-2002 documentou um aumento de prevalência de diabetes e obesidade e acredita-se que estas duas situações estão intimamente relacionadas com as mortes devidas às DCV. Entre 1976 e 2002 o número de pessoas com obesidade, definida como um IMC acima de 30 kg/m2 dobrou passando de 15% para 30%. A obesidade é o o mecanismo primário tanto para o desenvolvimento do diabetes como para as doenças cardiovasculares. Estas duas condições tem vários fatôres comuns como: resistência à insulina,hipertensão e dislipemia. Quando estes fatores de risco ocorrem simultâneamente falamos em síndrome metabólica.(SM)O que é Risco Cardiometabólico. Os Riscos Cardiometábolicos compreendem os componentes da SM e muitos outros alvos que, somente agora, estão sendo descobertos e que até recentemente não eram levados em consideração. As consequências de um tratamento sub-ótimo são largamente conhecidas pelos sistemas de saúde em várias partes do mundo. O têrmo risco cardiometabólico é definido como um conjunto (cluster) de fatores de risco modificáveis e diversos marcadores que estão presentes em alguns indíviduos com maior risco de infarto do miocárdio, doença cérebro vascular e doença arterial periférica. Estas alterações incluem: hipertensão arterial, resistência à insulina, hipertensão, elevação do LDL-C e TG,baixa do HDL-C, obesidade abdominal, microalbuminúria e alterações da função endotelial.Associação dos Fatores de RiscoOs fatores de risco cardiometabólico tendem a se associar formando um conglomerado de modo que raramente uma pessoa tem apenas 1 ou 2 fatores. Meigs e colegas fizeram uma clássica descrição deste conceito "associativo" num dos trabalhos com a população de Framignham.
Ele indentificou três fatores para o agrupamento destas variáveisO primeiro círculo, no meio do diagrama, representa a associação do níveis de insulina,TG e HDL-C,IMC e a razão quadril-cintura, todos os quais são associados com a SM.O segundo círculo é a combinação dos níveis de glicose e insulina, que são associados com a intolerância à glicose.O terceiro círculo inclue os valores de pressão sistólica e diastólica e mais o IMC que estão associados com a hipertensão. Como pode se ver no diagrama há uma sobreposição destes círculos mostrando uma associação destes vários fatôres: o metabólico, o inflamatório e a pressão arterial. Com este reconhecimento, as Associações de Cardiologistas e Diabetes, estão divulgando repetidamente, que existe algo mais do que tratar isoladamente da hipertensão, do coração, do colesterol, das glicemias ou da hemoglobina glicada. É preciso pensar mais longe e incorporar com mais rapidez estes conhecimentos à prática médica beneficiando milhões de pessoas que sofrem destas situações. A diminuição da inércia clínica e a melhoria dos indicadores da atenção médica, certamente, terão um grande impacto nos custos e na qualidade de vida da população que sofre com as doenças cardiovasculares. Em janeiro deste ano, a Associação Americana de Diabetes e a Associação Americana do Coração divulgaram mais uma das suas diretrizes médicas, relacionadas a este assunto e que podem ser lidas na revista Diabetes Care 30,162-171, Janeiro de 2007, que em resumo sugere: "endocrinologistas prestem mais atenção ao controle da PA dos seus clientes, cardiologistas olhem mais além do coração"Diabetes CareCardiology

Comentários dos leitores
Rafael Ferreira da Silva - 03-03-2007 15:45:13
Dr. Reginaldo de Holanda! Parabéns pela ótima matéria, onde a cada dia conhecemos um pouco mais por meio de artigos científicos do diabetes. Rafael - Brasília/DF. Medley S/A Indústria Farmacêutica.
Nossa resposta: Rafael: grato pelos seus comentários. Reginaldo Albuquerque - editor do site

Caffeine May Prevent Heart Disease Death In Elderly

Caffeine May Prevent Heart Disease Death In Elderly
Main Category: Seniors / Aging News
Article Date: 27 Feb 2007 - 7:00 PST
Habitual intake of caffeinated beverages provides protection against heart disease mortality in the elderly, say researchers at SUNY Downstate Medical Center and Brooklyn College.

Using data from the first federal National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the researchers found that survey participants 65 or more years old with higher caffeinated beverage intake exhibited lower relative risk of coronary vascular disease and heart mortality than did participants with lower caffeinated beverage intake.

John Kassotis, MD, associate professor of medicine at SUNY Downstate, said, "The protection against death from heart disease in the elderly afforded by caffeine is likely due to caffeine's enhancement of blood pressure."

The protective effect also was found to be dose-responsive: the higher the caffeine intake the stronger the protection. The protective effect was found only in participants who were not severely hypertensive. No significant protective effect was in patients below the age of 65.

No protective effect was found against cerebrovascular disease mortality - death from stroke - regardless of age.

neurological_disorders_report

Los trastornos neurológicos afectan a millones de personas en todo el mundo: informe de la OMS

27 DE FEBRERO DE 2007 | BRUSELAS/GINEBRA -- Según un nuevo informe de la Organización Mundial de la Salud (OMS), los trastornos neurológicos (desde la epilepsia y la enfermedad de Alzheimer o los accidentes cerebrovasculares hasta el dolor de cabeza) afectan en todo el mundo a unos mil millones de personas. Entre los trastornos neurológicos figuran también los traumatismos craneoencefálicos, las infecciones neurológicas, la esclerosis múltiple, y la enfermedad de Parkinson.

En el informe Neurological Disorders: Public health challenges (que próximamente se traducirá al español) se pone de manifiesto que en todo el mundo están afectadas unos mil millones de personas, 50 millones sufren epilepsia, y 24 millones padecen Alzheimer y otras demencias. Los trastornos neurológicos afectan a personas de todos los países, sin distinción de sexos, niveles de educación ni de ingresos.

Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies

PLoS Medicine - Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies
associated with coronary arteries that appear “normal.” Normal is defined here as no visible disease or luminal irregularities (less than 50%) as judged visually at coronary angiography. Normal angiography in patients with chest pain is five times more common in women than in men [1]. Among patients with chest pain and normal angiography, an unknown number are suffering from cardiac pain of ischemic origin. Uncertainty is often difficult to allay, for medical attendants as well as for patients, resulting in perpetuation of symptoms, difficulties in management, and establishment of risk of subsequent coronary events [2]. In this article, we discuss how to stratify risk in patients with chest pain and a normal coronary angiogram. We based our article on a literature review, using the key words “angina with normal angiography,” “angina with normal coronary arteries,” “non-obstructive coronary disease,” or “chest pain of non-cardiac origin,” plus “[a]etiology,” “pathophysiology,” “diagnosis,” “classification,” “prognosis,” or “therapy.” A longer, more detailed version of this paper is found in the supplementary file S1.

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association -- Antman et al., 10.1161/CIRCULATIONAHA.106.181424 -- Circulation

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association -- Antman et al., 10.1161/CIRCULATIONAHA.106.181424 -- Circulation
Clinical trial data have prompted questions about the degree to which patients and their physicians should consider an increased risk of cardiovascular or cerebrovascular events when selecting medications for pain relief. Since the 2005 publication of a Science Advisory on the use of nonsteroidal antiinflammatory drugs (NSAIDs) by the American Heart Association,1 several important events have occurred that have served as the catalyst for this update for clinicians. (1) Additional data from randomized controlled trials of cyclooxygenase (COX)-2–selective agents have been reported and summarized in meta-analyses, which has reinforced the concern about cardiovascular events with COX-2 inhibitors (coxibs; Figure 1). (2) Several reports have appeared that have identified an increased risk of cardiovascular events even with the nonselective NSAIDs, which has raised concern about the use of those agents as well (Table). (3) Regulatory authorities in several regions of the world have introduced warning statements and advisories to both healthcare professionals and the lay public about the use of various NSAIDs (Figures 2 and 3)./.../

Distribuição espacial da mortalidade por infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil

O objetivo deste estudo é analisar a distribuição espacial da mortalidade por infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil. Foram analisados dados sobre mortalidade por infarto agudo do miocárdio ocorrido em 2000, por meio do Sistema de Informação de Mortalidade. Utilizou-se o modelo bayesiano empírico de suavização a fim de minimizar a variabilidade aleatória dos coeficientes de mortalidade associada ao tamanho das unidades geográficas de análise. A distribuição dos óbitos por infarto agudo do miocárdio na cidade é heterogênea e obedece a um padrão espacial associado a um forte gradiente social. O padrão de sub-risco de mortalidade por infarto agudo do miocárdio observado na Zona Oeste não condiz com o perfil de desigualdade social e de acesso aos serviços de saúde observado na área. Acredita-se que o risco de morrer por infarto agudo do miocárdio foi subestimado em função da alta proporção de óbitos por causa mal definida na área. O padrão espacial de mortalidade apresentou uma concentração do risco de morrer de infarto nas áreas mais pobres da cidade. As diversas unidades de saúde apresentam áreas de influência para o atendimento ao infarto agudo do miocárdio.

Quotes: Geoffrey Rose

Quotes: Geoffrey Rose

In the Stent Era, Heart Bypasses Get a New Look - New York Times

In the Stent Era, Heart Bypasses Get a New Look - New York Times
After more than a decade-long decline, is heart bypass surgery poised for a comeback?

Reconsidering Heart Bypass Surgery Some doctors say it may be time to give bypass operations a second look, including some cardiologists who specialize in the far more popular alternative — using stents to keep coronary arteries propped open.

No one is predicting a sudden surge back to bypass, which is still a far more invasive and initially riskier way to treat plaque-clogged heart arteries, a condition that afflicts millions of Americans.

The effect of statin therapy on infection-related mortality in patients with atherosclerotic diseases.

De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: sexta-feira, 23 de fevereiro de 2007 23:35

The effect of statin therapy on infection-related mortality in patients with atherosclerotic diseases.
Crit Care Med. 2007 Feb;35(2):372-8. Related Articles, Links

Almog Y, Novack V, Eisinger M, Porath A, Novack L, Gilutz H.

Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.

OBJECTIVE: Statins have pleiotropic effects that are independent of their lipid-lowering ability. We have previously shown that prior statin therapy is associated with a decreased risk of severe sepsis in patients admitted with acute bacterial infection. The aim of this study was to determine whether statin therapy is associated with a decreased risk of infection-related mortality. DESIGN: A prospective, observational, population-based study. SETTING: Tertiary university medical center. PATIENTS: Using a computerized database, 11,490 patients with atherosclerotic diseases were identified and followed for up to 3 yrs. Two groups of patients were compared: those receiving statins in the final month before follow-up termination and those who were not. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was infection-related mortality. Of the 11,362 patients included in the final analysis, 5,698 (50.1%) belonged to the statin group. Median follow-up was 19.8 months (interquartile range, 14.3-33.3). The risk of infection-related mortality was significantly lower in the statin compared with the no-statin group (0.9% vs. 4.1%), reflecting a relative risk of 0.22 (95% confidence interval, 0.17-0.28). Stepwise Cox proportional hazard survival analysis including a propensity score for receiving statins revealed that the protective effect of statins adjusted for all known potential confounders remained highly significant (hazard ratio, 0.37; 95% confidence interval, 0.27-0.52). CONCLUSIONS: Therapy with statins may be associated with a reduced risk of infection-related mortality. This protective effect is independent of all known comorbidities and dissipates when the medication is discontinued. If this finding is supported by prospective controlled trials, statins may play an important role in the primary prevention of infection-related mortality.

PMID: 17205009 [PubMed - in process]

Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part I:

(Texto completo, bem como da parte II, a disposição para quem me enviar mensagem solicitandouma copia *pdf)
Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part I: The Electrocardiogram and Its Technology. A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology
Paul Kligfield MD, FAHA, FACC, Leonard S. Gettes MD, FAHA, FACC, James J. Bailey MD, Rory Childers MD, Barbara J. Deal MD, FACC, E. William Hancock MD, FACC, Gerard van Herpen MD, PhD, Jan A. Kors PhD, Peter Macfarlane DSc, David M. Mirvis MD, FAHA, Olle Pahlm MD, PhD, Pentti Rautaharju MD, PhD, and Galen S. Wagner MD

Abstract--This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Throughout the statement, recommendations for ECG standards are placed in context of the clinical implications of evolving ECG technology.

siesta for a healthy heart -

Embrace your siesta for a healthy heart - International Herald Tribune: "Could midday napping save your life?

If the experience of Greek men is any guide, the answer just may be yes.

In a study released yesterday, researchers at the Harvard School of Public Health and in Athens reported that Greeks who took regular 30-minute siestas were 37 percent less likely to die of heart disease over a six-year period than those who never napped. The scientists tracked more than 23,000 adults, finding that the benefits of napping were most pronounced for working men.

Researchers have long recognized that Mediterranean adults die of heart disease at a rate lower than Americans and Northern Europeans. Diets rich in olive oil and other heart-healthy foods have received some of the credit, but scientists have been intrigued by the potential role of napping.

The study, published in the Archives of Internal Medicine, concluded that napping was more likely than diet or physical activity to lower the incidence of heart attacks and other life-ending heart ailments."

Improved Cardiovascular Risk Predictor Developed for Women

Improved Cardiovascular Risk Predictor Developed for Women - CME Teaching Brief® - MedPage Today: "OSTON, Feb. 13 -- Two new risk factors added to the traditional risk model enhanced prediction of a woman's 10-year risk of cardiovascular disease or stroke, researchers reported.

Two versions of the revised model, with validated risk algorithms, reclassified 40% to 50% of women at 10-year risk into higher- or lower-risk categories, according to a report in the Feb. 14 issue of the Journal of the American Medical Association."

ACC/AHA 2007 Methodology for the Development of Clinical Data Standards. A Report of the American College of Cardiology/American Heart Association Tas

ACC/AHA 2007 Methodology for the Development of Clinical Data Standards. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards -- TASK FORCE MEMBERS et al., 10.1161/CIRCULATIONAHA.107.182215 -- Circulation

Stroke Risk With Migraine Aura Makes Birth Control Pill Problematic

ASA: Stroke Risk With Migraine Aura Makes Birth Control Pill Problematic - CME Teaching Brief® - MedPage Today: "SAN FRANCISCO, Feb. 12 -- Women under age 35 who suffer migraine with aura should consider avoiding oral hormonal contraception because of their elevated risk of a stroke."

Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Hea

Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians -- Grines et al. 115 (6): 813 -- Circulation: "Dual antiplatelet therapy with aspirin and a thienopyridine has been shown to reduce cardiac events after coronary stenting. However, many patients and healthcare providers prematurely discontinue dual antiplatelet therapy, which greatly increases the risk of stent thrombosis, myocardial infarction, and death. This advisory stresses the importance of 12 months of dual antiplatelet therapy after placement of a drug-eluting stent and educating the patient and healthcare providers about hazards of premature discontinuation. It also recommends postponing elective surgery for 1 year, and if surgery cannot be deferred, considering the continuation of aspirin during the perioperative period in high-risk patients with drug-eluting stents.

"

Educação Continuada

Educação Continuada
Revistas com acesso para sócios da SBC
Annals of Internal Medicine
American Heart Journal(AHJ)
Archives of Internal Medicine
Thrombosis, and Vascular Biology
BMJ
Cardiology in Review
Chest
Circulation
Circulation Research
Clinical Journal of Sport Medicine
Coronary Artery Disease
Critical Pathways in Cardiology
Current Opinion in Cardiology
Current Opinion in Endocrinology & Diabetes
Diabetes Care
Epidemiology
European Heart Journal
European Journal of Cardiovascular Prevention and Rehabilitation
Heart
Hypertension
JAMA
Journal of Cardiovascular Electrophysiology
Journal of Cardiovascular Pharmacology
Journal of Hypertension
Journal of the American Society of Echocardiography
New England Journal of Medicine
Pacing & Clinical Electrophysiology
Stroke

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee -- Rosamond et al. 115 (5): e69 -- Circulation: "The American Heart Association (AHA) works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Update. This chapter describes the most important sources and the types of data we use from them. For more details and an alphabetical list of abbreviations, see Chapter 21 of this document, the Glossary and Abbreviation Guide."

Associations of Gestational Age and Intrauterine Growth With Systolic Blood Pressure in a Family-Based Study of 386 485 Men in 331 089 Families -- Law

Background— We conducted a family-based study to explore mechanisms underlying the associations of birth weight and gestational age with systolic blood pressure measured at 17 to 19 years of age.

Methods and Results— A record linkage study of 386 485 singleton-born men from 331 089 families was undertaken. Birth weight was inversely associated with systolic blood pressure within siblings, with a mean difference (adjusted for age at examination, examination center, and year of examination) within siblings per 1-SD difference in birth weight of –0.21 mm Hg (95% CI, –0.33 to –0.08) and between nonsiblings of –0.12 (95% CI, –0.16 to –0.08). Gestational age was inversely associated with systolic blood pressure within siblings (–0.18 mm Hg; 95% CI, –0.25 to –0.11, per week of gestational age) and between nonsiblings (–0.26 mm Hg; 95% CI, –0.29 to –0.24). Adjustment for socioeconomic position and maternal characteristics did not alter these within- or between-family associations. Furthermore, the associations were not affected by adjustment for paternal height, body mass index, or systolic blood pressure.

Conclusions— Our present findings suggest that the inverse associations of birth weight and gestational age with systolic blood pressure are not explained by confounding resulting from family socioeconomic position or other factors that are shared by siblings. Variations in maternal metabolic or vascular health during pregnancy or placental implantation and function may explain these associations.

Management of congenital stenosis of a branch pulmonary artery with balloon dilation angioplasty. Report of 52 procedures

Twenty-four children, aged 4 months to 16 years (nine patients 2 years old or younger), underwent balloon dilation angioplasty of hypoplastic or stenotic branch pulmonary arteries between July, 1981, and April, 1984. Most children had tetralogy of Fallot, with or without pulmonary atresia, or isolated peripheral pulmonary artery stenosis. Fifty-two dilations were attempted, 44 in the catheterization laboratory and eight in the operating room. Of these, 26 (50%) were judged successful; the average vessel diameter on angiogram increased from 4.1 +/- 0.3 to 7.2 +/- 0.3 mm (76%), the gradient across the narrowed segment fell from 60 +/- 10 to 36 +/- 5 mm (40%), pressure in the main pulmonary artery or right ventricle proximal to the obstruction decreased from 83 +/- 10 to 66 +/- 6 mm Hg (20%), and the radionuclide-determined fraction of cardiac output directed to the lung ipsilateral to the dilated pulmonary artery increased from 40 +/- 4 to 51 +/- 4 (28%). All changes were significant at the p less than 0.005 level. Reasons for failure included inadequate technique (balloon too small, inability to position balloon or wire) in 14 and the refractory nature of the lesion itself in 11. Technical failures were age independent. Nondilatable lesions were more common in children more than 2 years old (10/25 versus 1/10) or with isolated peripheral pulmonary artery stenosis (5/7). Five of seven stenoses near previous shunts were nondilatable. One child exsanguinated when the pulmonary artery ruptured during dilation, but other complications were few. Eight dilations, followed up for an average of 6 months after dilation, showed angiographic persistence of improvement; two of four lesions were successfully redilated to a larger size. Balloon dilation angioplasty appears beneficial, both short and long term, for some patients with hypoplastic or stenotic branch pulmonary arteries, especially if performed early in life.

TIA-to-Stroke Risk Prediction Easy As A-B-C-D2

TIA-to-Stroke Risk Prediction Easy As A-B-C-D² - CME Teaching Brief® - MedPage Today: "The ABCD2 score is based on age, blood pressure, clinical features, diabetes, and TIA duration. It predicts stroke risk during the two-day window during which half of subsequent strokes occur, the researchers said.

Although the study validated the utility of both the existing California and ABCD scales, the new tool is likely to be more useful for emergency management and creates a single standard for use in clinical care and public education, Dr. Johnston and colleagues said.

'Identifying those at highest and lowest risk of stroke in the first days and weeks after a TIA would allow more appropriate utilization of costly secondary prevention strategies, including hospitalization,' they wrote.

'The California Score was developed to predict stroke within 90 days and the ABCD score predicts seven-day stroke risk, whereas the two-day stroke risk is often most relevant for decisions about necessity of emergent evaluation and observation,' they added."

Indications for Heart Transplantation in Pediatric Heart Disease.

Indications for Heart Transplantation in Pediatric Heart Disease. A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group -- Canter et al., 10.1161/CIRCULATIONAHA.106.180449 -- Circulation: Background--Since the initial utilization of heart transplantation as therapy for end-stage pediatric heart disease, improvements have occurred in outcomes with heart transplantation and surgical therapies for congenital heart disease along with the application of medical therapies to pediatric heart failure that have improved outcomes in adults. These events justify a reevaluation of the indications for heart transplantation in congenital heart disease and other causes of pediatric heart failure.

Methods and Results--A working group was commissioned to review accumulated experience with pediatric heart transplantation and its use in patients with unrepaired and/or previously repaired or palliated congenital heart disease (children and adults), in patients with pediatric cardiomyopathies, and in pediatric patients with prior heart transplantation. Evidence-based guidelines for the indications for heart transplantation or retransplantation for these conditions were developed.

Conclusions--This evaluation has led to the development and refinement of indications for heart transplantation for patients with congenital heart disease and pediatric cardiomyopathies in addition to indications for pediatric heart retransplantation."

New Guidelines Issued for Venous Thromboembolism

New Guidelines Issued for Venous Thromboembolism - CME Teaching Brief® - MedPage Today: "Other conclusions were as follows:

* Fifteen studies support that when a D-dimer assay is negative and a clinical prediction rule suggests a low probability of DVT or pulmonary embolism, the negative predictive value is high enough to justify forgoing imaging studies in many patients.
* The evidence in five systematic reviews regarding the use of D-dimer, in isolation, is strong and demonstrates sensitivities of the enzyme-linked immunosorbent assay (ELISA) and quantitative rapid ELISA, pooled across studies, of approximately 95%.
* Eight systematic reviews found that the sensitivity and specificity of ultrasonography for diagnosis of DVT vary by vein. Ultrasonography performs best for diagnosis of symptomatic, proximal vein thrombosis, with pooled sensitivities of 89% to 96%.
* The sensitivity of single-detector helical computed tomography for diagnosis of pulmonary embolism varied widely across studies and was below 90% in four of nine studies. More studies are needed to determine the sensitivity of multidetector scanners."

Human metabolism recreated in lab

BBC NEWS | Health | Human metabolism recreated in lab: "'It's increasingly recognised there are these networks of metabolism and we need to know if we target something how that will spread out and this is potentially a way of dealing with that.'

Dr Anthony Wierzbicki, consultant in specialist laboratory medicine at St Thomas's hospital, has done a lot of work on the role of cholesterol in heart disease.

'This is a potentially interesting tool for investigating metabolism of which cholesterol biochemistry forms a part,' he said.

But he added that the model would have to be 'sophisticated' enough to predict what happens in the production and breakdown of cholesterol as well how it is absorbed from the gut as the two were closely linked."

Pioneering heart surgery trialled

BBC NEWS | UK | England | Leicestershire | Pioneering heart surgery trialled: "Dr Jan Kovac, consultant cardiologist at Glenfield Hospital, said: 'In the past, patients had to endure open heart surgery and would have been in hospital for at least a week after their operation.

'This new catheter treatment is much quicker and in most cases patients will be back home within a few days of having the operation.

'This technique is the biggest invention in cardiology over the last 30 years since the introduction of the coronary angioplasty.'"

Preventing stroke: saving lives around the world

The Lancet Neurology

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: terça-feira, 23 de janeiro de 2007 17:28
Para: procor@healthnet.org
Assunto: [ProCOR] Lancet Neurology: Stroke in developing countries: can theepidemic be stopped and outcomes improved?

["Two-thirds of the global burden of stroke occurs in low-income and middle-income countries, but accurate data on stroke incidence in these countries are scarce. Stroke surveillance systems--which are absent in virtually all resource-poor countries--are essential to obtain an accurate picture of the burden of stroke and to enable policymakers to plan cost-effective strategies....There have been attempts to collect reliable data, and there is a will to do so, but the lack of sound methodology and effective surveillance render studies uninformative or incomparable. As an entry point for countries to begin registration of patients with stroke, WHO recommends a stepwise approach to stroke surveillance (STEPS Stroke). This approach enables researchers to gather information on stroke through identification of the three major subsets of patients that comprise a population's stroke burden: those admitted to hospital (step 1); those who have stroke events that are fatal before admission to hospital (step 2); and those with non-fatal strokes who are cared for entirely in the community (step 3). ("STEPS in the right direction," The Lancet Neurology 2007;
6(2): 93).]

-----

The article below, "Stroke in developing countries: can the epidemic be stopped and outcomes improved?" appears (free full text) in the current issue of The Lancet Neurology. Link to the issue at http://neurology.thelancet.com. For those who cannot access the articles online, excerpts are provided below. We welcome your comments.

To help people who want to establish either hospital-based or population- based stroke registers, WHO provides resources at www.who.int/chp/steps/stroke, including a manual which explains in detail how to develop such a register and an application form/criteria for free access to a Data Entry Tool.

------------------
"Stroke in developing countries: can the epidemic be stopped and outcomes improved?"
Valery L Feigin
Free full text:
http://www.thelancet.com/journals/laneur/article/PIIS1474442207700078/fulltext

Excerpts:
According to WHO estimates, death from stroke in developing (low and
middle-income) countries in 2001 accounted for 85*5% of stroke deaths worldwide, and the number of disability-adjusted life years (DALYs), which comprises years of life lost and years lived with disability, in these countries was almost seven times that in developed (high-income) countries. [1] Stroke burden is likely to increase as a result of ageing and population growth if action is not taken now to remove or reduce the well-established determinants of stroke.

Although good-quality data on the epidemiology, prevention, and management of stroke are rapidly accumulating for economically developed countries, particularly over the past two decades, there is a lack of reliable data for developing countries. These issues and the future of applied stroke research and implementation strategies in these countries are the focus of a series of Review articles, the first of which is published in this issue of The Lancet Neurology.

On the basis of the recent WHO re-assessments of the original Global Burden of Disease (GBD) study and the WHO 2002 mortality estimates, with substantial improvements in data availability and some new methods for dealing with incomplete and biased data, Strong and colleagues [2] review current and projected stroke mortality and burden (as measured in DALYs) for the world, World Bank income groups, and selected countries for the period from 2005 to 2030. The authors estimate that the current global burden of stroke is 16 million first-ever strokes, 62 million stroke survivors, 51 million DALYs, and
5*7 million deaths in 2005. Without additional population-wide interventions, figures are predicted to increase to a staggering 23 million first-ever strokes,
77 million stroke survivors, 61 million DALYs, and 7*8 million deaths by 2030.
Strong and colleagues' data also show that stroke is already a leading cause of death and disability in low and middle-income countries and in the global population under age 70 years, and that 87% of global stroke mortality in 2005 (a 1*5% increase compared with 2001) occurred in these countries, with Russia at the top of the list.

However, if there were a 2% reduction per annum in stroke mortality (due to better management), this would result in 6*4 million fewer deaths from stroke between 2005 and 2015, with most deaths averted and years of life gained in low and middle-income countries. The experience of high-income countries has shown the feasibility of such reductions. The authors advocate a wider use of early administration of aspirin for ischaemic stroke in low and middle-income countries. However, they also correctly argue that the most important contribution to the reduction of stroke mortality in these countries is likely to come from primary prevention, with the emphasis on the major risk factors common to stroke, heart disease, diabetes, and other chronic diseases.

...

What can we learn from these studies? First, we are witnessing an epidemic of stroke in developing countries. The burden of stroke will be even greater if appropriate measures are not taken. Second, there is a lack of reliable and comparable data on stroke incidence, prevalence, causes, trends, management, and outcomes to inform efficient and sustainable health care and prevention strategies in developing countries. The gap in knowledge on stroke epidemiology between developed and developing countries is also widening. Third, despite apparent differences in the patterns of stroke types and risk factor profiles between developed and developing countries, most occurrences of stroke and cardiovascular disease can be attributed to conventional risk factors, [7,8] and some prevention and management strategies are likely to be equally applicable to all countries and populations. The question is whether we should wait until further evidence on stroke epidemiology, prevention, and management is available from developing countries or act now to stop the stroke epidemic and improve outcomes. On the basis of the available evidence, we should act now. Stroke must be a priority on the health agenda in all countries. This leads us to the next logical questions. How best should we proceed to stop the epidemic and improve stroke outcomes in developing countries, given their very limited resources and many competing demands? How best can we monitor the effects of these interventions at the population level in developing countries? What are the directions of future applied stroke research in these countries?

Given the limited resources available for health care in developing countries, it would be logical to place emphasis on effective population-wide interventions to control or reduce exposure to leading risk factors, such as raised blood pressure, smoking, high cholesterol, low fruit and vegetable intake, physical inactivity, and alcohol excess. [9] Population-wide efforts to reduce salt intake and tobacco use through multiple economic and educational policies and programmes have been suggested as cost-effective primary prevention interventions in developing countries. [7]

Primary prevention measures should be complemented with proven secondary prevention measures, such as early aspirin use in patients with acute ischaemic cerebrovascular events, prescription of blood-pressure-lowering drugs to all patients with stroke, and basic multidisciplinary acute stroke units in hospitals that provide emergency care for patients. Development of consensus statements and national stroke guidelines by recognised experts from the region to address local issues on the basis of the best available evidence should also be encouraged and their use supported. Effective strategies to improve stroke awareness (including campaigns to remove stigma associated with stroke) and training of healthcare workers in the regions need to be developed and implemented on a larger scale. [7,10]

Further research is needed to trial other affordable and potentially widely applicable primary and secondary prevention strategies, such as a polypill containing aspirin, blood-pressure-lowering drugs, statin, and perhaps folic acid. [11] More research also needs to be done to assess indigenous medicines and compare various capacity-building strategies. [7] Emphasis should be placed on effectiveness and efficiency of the interventions in the specific context of developing countries. [7,10] Monitoring of effects of interventions at the population level and obtaining comparable and reliable data on stroke incidence, prevalence, and risk factors in developing countries deserves further attention.
[7,12] The ascertainment of numbers of hospitalised stroke patients in the WHO STEPwise approach to stroke surveillance [13] seems feasible, but the other two suggested steps (ascertainment of fatal stroke events in the same community, and especially the ascertainment of non-fatal, non-hospitalised stroke events in the same community) may be challenging in many low and middle-income countries. An alternative approach for studying stroke incidence and prevalence in countries with very limited resources could include a combination of a stroke prevalence survey (eg, door-to-door study) with a study of death certificates (verbal autopsy procedures) in the same community (figure). The key idea of this approach is that nonfatal first-ever stroke events within the preceding 3 years in the defined population are identified among prevalent cases of stroke (prevalence survey) and then combined in the analysis with fatal first-ever stroke events in the same population for the same study period to calculate cumulative stroke incidence rates. The standard WHO definition of stroke should be used to allow comparisons. [14] This design for studying stroke incidence has been used in Italy [15] and China [16] and shown to be valid. [15]

...

Only through a comprehensive approach, combining applied stroke research with sustainable, affordable and context-specific evidence-based prevention and management strategies will it be possible to stem the global stroke epidemic, improve outcomes, monitor burden, and save millions of lives around the world.

Valery L Feigin
Clinical Trials Research Unit, School of Population Health, The University of Auckland, New Zealand

Expanding Priorities -- Confronting Chronic Disease in Countries with Low Income

NEJM -- Expanding Priorities -- Confronting Chronic Disease in Countries with Low Income: "In a ceremony held at the New York Public Library on June 26, 2006, Microsoft founder and global health philanthropist Bill Gates expressed his belief that 'there is no reason we can't cure the top 20 diseases.'1 To achieve this ambitious objective, however, international health organizations will need to greatly expand their efforts, especially in low-income countries, to prevent and treat noncommunicable chronic diseases.

Although there are many ways to classify diseases and to evaluate the burden of disease, it is clear that by any measure, several noncommunicable chronic diseases have a place in the global top 20. For example, cardiovascular disease alone accounts for nearly 30% of all deaths worldwide and 10% of all years of healthy life lost to disease (called 'disability-adjusted life-years'; see graphs).2 In low-income and lower-middle-income countries (countries with a per capita gross national product of less than $3,255 in 2004), the corresponding figures are similar to the global ones — 27% and 9%, respectively."/.../

Medicamentos para o SUS (2) - Provocação do Eduardo Costa

De: Eduardo A Costa [mailto:eduacosta@terra.com.br]
Enviada em: sábado, 6 de janeiro de 2007 11:12
Para: Aloyzio Achutti
Assunto: Re: [2333 - AMICOR-06/01/2007]


Caro amigo Achutti e todos AMICOR,

Tenho um gosto particular pela polêmica, isto é, uma visão de um outro ângulo do mesmo fenômeno.
A visão hegemônica, esconde as outras e deixa encoberto o lado oculto da lua, que nesse caso pode ser fácil de deduzir pela superfície que vemos.
Não é o caso na maioria das vezes. O outro lado é oposto. Vive junto e não aparece. É a cara da moeda. Na coroa está o valor.
Pois bem, o MS em 2003 comprava diretamente 5% de seu orçamento em medicamentos, cerca de 1,5 bilhões de reais e em 2006, gastou 4,2 bilhões, quase 3 vezes mais, agora 11% do seu orçamento. Não está incluido o que repassa para tal fim aos estados e muncipios que também gastam de seus orçamentos, nem o subsidio da Farmácia Popular.
Na face mais visível e utilizada para comprovar o cuidado do Governo com a saúde houve um avanço da política social.
O outro lado é o verdadeiro cifrão (pq não volta para a economia do país, não gera empregos, nem é consumido nos botequins e supermercados brasileiros) : crescem a importação de fármacos e medicamentos e o deficit anual de nosso balanço de pagamentos externo do setor saúde é de mais de 4 bilhões de dólares, sendo quase 3 bilhões em medicamentos e vacinas (10%).
Não temos estimativa de quanto aumentou o acesso dos que precisam a medicamentos, mas aumentou marginalmente.
O destino do aumento de orçamento foram medicamentos patenteados, ou seja monopolizados por alguma grande companhia. Essas continuam a bloquear como podem a indústria nacional.
Para exemplificar: no programa de AIDS (170 mil em tratamento) o orçamento desse ano de 2006 para medicamentos foi de 1,2 bilhões de reais. Os laboratórios oficiais que fornecem 80% das unidades farmacêuticas recebem cerca de 25% dos recursos. Os quase 800 milhões vão para a compra para tratar 30 mil pacientes.
Nada contra. O problema é que não dá mais para acreditar que é cientificamente correto (com a conhecida prática dos conflitos de interesses) e a vulnerabilidade do processo decisório de incorporação aos procedimentos dos "consensos" e da tecnoburocracia estatal.
Não podemos deixar de lembrar que, via de regra, os médicos na maioria dos paises são "treinados" sob a forte pripaganda médica direta ou sutil, em congressos e mesmo na faculdade.
Considero urgente uma revisão dos critérios para a prescrição e incorporação dos "medicamentos de uso excepcional", pois aí está o grande rombo.
Nesse email não vou detalhar mais, mas queria justificar o debate que propus.
E mais, defendo também e com bons dados que o controle de preços não é só sobre preços altos, estamos vivendo frequentemente dumping (preços mais baixos) para tirar o estado ou o nacional do mercado. Depois de sós, voam os preços de novo.
Deixo para outra oportunidade contar alguns dados nossos (de Farmanguinhos) e em particular o último episódio com a insulina humana.
Mas, o centro do questionamento técnico de epidemiologistas clínicos deve partir, na minha opinião:
1 - Clara avaliação dos riscos, não só das vantagens (se devidamente e criticamente estabelecidas);
2 - Contrapor riscos relativos a riscos atribuíveis na população.
3 - Vantagem relativa, sobre o tratamento com medicamentos ou alternativas já bem conhecidas;
4 - Procedimentos para a exclusão de terapêuticas das listas ou recomendações.

Sei que para isso deveríamos ter uma farmacovigilância bem alimentada - raramente as suspeitas de reações adversas são comunicadas e a elas se dá o devido destaque na apuração e organização da informação para a ação.
Mas debater o assunto já é bom.

Abraços a todos, bom ano novo

Eduardo Costa

AMICOR 10 anos...

Agradeço as menifestações de carinho e sugestões de vários AMICOR.
Enquanto estamos recolhendo novas sugestões e planejando o futuro, gostaria desde já transcrever parte de mansagem recebida do PADRINHO AMICOR (como todos sabem, foi o Eduardo de Azeredo Costa que sugeriu o nome da lista, ao ver que as mensagens começavam sempre com "Caros amigos do coração").
O desafio é válido e provocador. Desde já podemos começar e/ou ir pensando nele.
Um abraço
AA
...
...No dia 12 passado comemorei de maneira singular meus 40 anos de formatura, sem que eu mencionasse isso, inaugurei uma nova área de produção de medicamentos para hipertensão e diabete e homenagiei o Fadul, último Ministro do Jango, que nos deixou um legado fantástico e ignorado na luta contra os negócios excusos das multinacionais dos medicamentos (em geral os susistas o mencionam porque organizou a 3a. conferência nacional de saúde com o tema central na municipalização da atenção básica).

O discurso do Jango na assinatura do decreto que criou o Geifar (grupo executivo da indústria farmacêutica) é de grande atualidade. Impressionante o que não se sabe que ele fez em pouco mais de dois anos, 40 e poucos anos depois: a primeira lista RENAME, o CADE, a normatização da SECEX para coibir o supoerfaturamento e os dumpings das multis, entre outras coisas.

Nas comemorações dos 10 anos do AMICOR tenho uma sugestão a fazer: porque não pensar em estabelecer um debate sobre a incorporação tecnológica ao SUS na área de medicamentos e equipamentos?

A palavra para definir o descalabro hoje é desvairo orientado para proteger as multis e aumentar nossos gastos....... O que v acha de começar na área cardiovascular definindo uma lista boa e deixar os Amicor discutir os pros e contra? Poruqe e quando substituir uma sinvastatina por outra patenteada? Qual a evidência real, etc.

........
Eduardo

Cardiosource: ACC Clinical Collection on Coronary Syndromes

Cardiosource: "Dec 20, 2006 unlocked content Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndromes: An Electronic Medication Monitoring System (J Am Coll Cardiol)
Dec 20, 2006 unlocked content Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events (J Am Coll Cardiol)
Dec 20, 2006 unlocked content Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction (Arch Intern Med)
Dec 20, 2006 locked content Bupropion is not helpful for long term smoking cessation in patients hospitalized with acute coronary syndrome. (Am J Med)/.../"

The Year in Cardiology -

The Year in Cardiology - CME Teaching Brief® - MedPage Today: "Additional Acute Coronary Syndrome Coverage



ATLANTA, Jan. 4 -- Among cardiologists, 2006 will be remembered as the year in which the value of tight cholesterol control was confirmed, the value of various vitamin regimens for preventing heart disease was questioned, a once promising lipid therapy was derailed, and enthusiasm for drug-eluting stents was dampened.

The following summary reviews some of the highlights of the year in cardiology. For fuller accounts, links to the individual articles published in MedPage Today have been provided.

How Low Can You Go?
/.../

FTC Fines Diet Pill Makers Millions for Bogus Claims

FTC Fines Diet Pill Makers Millions for Bogus Claims - CME Teaching Brief® - MedPage Today: "WASHINGTON, Jan. 4 -- The Federal Trade Commission said today that it fined four makers of over-the-counter weight-loss products more than $25 million for false advertising, including a $3.2 million civil penalty against Bayer for claims made for One-A-Day Weight Smart.

FTC chairman Deborah Platt Majoras said the Bayer fine was the largest civil penalty ever levied by the agency.

She added that none of the four products involved -- One-A-Day Weight Smart, Xenadrine EFX, Cortislim, and TrimSpa -- posed a health risk to users. None was removed from store shelves.

The Bayer settlement, which was filed yesterday in U.S. Court in the District of New Jersey, came after Bayer had violated an earlier FTC order directing it to cease what Majoras said were bogus weight loss claims for its Weight Smart product, which added green tea extract to a standard multivitamin compound./.../"

Promotion of Faster Weight Gain in Infants Born Small for Gestational Age. Is There an Adverse Effect on Later Blood Pressure?

Promotion of Faster Weight Gain in Infants Born Small for Gestational Age. Is There an Adverse Effect on Later Blood Pressure?
Atul Singhal, MD, MRCP; Tim J. Cole, PhD, ScD; Mary Fewtrell, MD, MRCP; Kathy Kennedy, MSc; Terence Stephenson, DM, FRCP, FRPCH; Alun Elias-Jones, FRCP, FRCPCH; Alan Lucas, MD, FRCP, FMed Sci
Background—Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age (birth weight
10th percentile).
Methods and Results—Blood pressure was measured at 6 to 8 years in 153 of 299 (51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean (but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula (unadjusted mean difference for diastolic blood pressure, 3.2 mm Hg; 95% CI, 5.8 to 0.5; P0.02) independent of potential confounding factors (adjusted difference, 3.5 mm Hg; P0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.
Conclusions—In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative “overnutrition” in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age. (Circulation. 2007;115:)

Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke

Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke
A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhD
Executive Summary
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for
heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus
A Scientific Statement From the American Heart Association and the
American Diabetes Association . John B. Buse, MD, PhD, Co-chair; Henry N. Ginsberg, MD, FAHA, Co-chair; George L. Bakris, MD, FAHA; Nathaniel G. Clark, MD, MS, RD; Fernando Costa, MD, FAHA; Robert Eckel, MD, FAHA; Vivian Fonseca, MD; Hertzel C. Gerstein, MD, MSc, FRCPC; Scott Grundy, MD, FAHA; Richard W. Nesto, MD, FAHA; Michael P. Pignone, MD, MPH; Jorge Plutzky, MD; Daniel Porte, MD; Rita Redberg, MD, FAHA; Kimberly F. Stitzel, MS, RD; Neil J. Stone, MD, FAHA
Abstract—The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ. (Circulation. 2007;115:114-126.)

Triglycerides and the Risk of Coronary Heart Disease

Triglycerides and the Risk of Coronary Heart Disease
10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies
Nadeem Sarwar, MPhil; John Danesh, DPhil; Gudny Eiriksdottir, MSc; Gunnar Sigurdsson, PhD; Nick Wareham, PhD; Sheila Bingham, PhD; S. Matthijs Boekholdt, PhD;
Kay-Tee Khaw, MBBChir; Vilmundur Gudnason, PhD
Background—Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated
meta-analysis of 27 additional prospective studies in general Western populations.
Methods and Results—Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years
apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident
coronary heart disease cases from 262 525 participants in 29 studies.
Conclusions—Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations. (Circulation. 2006;114:&NA;-.)

Postraumatic Stress Found Cardiotoxic in Older Veterans - CME Teaching Brief® - MedPage Today

Postraumatic Stress Found Cardiotoxic in Older Veterans - CME Teaching Brief® - MedPage Today: "Postraumatic Stress Found Cardiotoxic in Older Veterans


By Judith Groch, Senior Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
January 02, 2007
Additional Acute Coronary Syndrome Coverage


BOSTON, Jan. 2 -- More severe posttraumatic stress disorder (PTSD) increased the risk of coronary heart disease and myocardial infarction in older male veterans, researchers reported."