What is the deadliest disease in the world?

WHO | What is the deadliest disease in the world?
Q: What is the deadliest disease in the world?

A: The results of ranking the leading causes of death are subject to the cause categories used. The broader the cause categories used, the more likely they will rank among the top leading causes of death.

According to the estimates in The world health report 2004, there were 57 million deaths in the world in 2002. The broad category of all "noncommunicable diseases" killed 33.5 million people; communicable diseases, maternal and perinatal conditions, and nutritional conditions killed 18.3 million people worldwide; and external causes of injuries killed 5.2 million people.

When analysing at disaggregated level, the following are the leading causes of death:

Pathophysiology of Coronary Artery Disease -- Libby and Theroux 111 (25): 3481 -- Circulation

Pathophysiology of Coronary Artery Disease -- Libby and Theroux 111 (25): 3481 -- Circulation:
(Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]

"During the past decade, our understanding of the pathophysiology of coronary artery disease (CAD) has undergone a remarkable evolution. We review here how these advances have altered our concepts of and clinical approaches to both the chronic and acute phases of CAD. Previously considered a cholesterol storage disease, we currently view atherosclerosis as an inflammatory disorder. The appreciation of arterial remodeling (compensatory enlargement) has expanded attention beyond stenoses evident by angiography to encompass the biology of nonstenotic plaques. Revascularization effectively relieves ischemia, but we now recognize the need to attend to nonobstructive lesions as well. Aggressive management of modifiable risk factors reduces cardiovascular events and should accompany appropriate revascularization. We now recognize that disruption of plaques that may not produce critical stenoses causes many acute coronary syndromes (ACS). The disrupted plaque represents a 'solid-state' stimulus to thrombosis. Alterations in circulating prothrombotic or antifibrinolytic mediators in the 'fluid phase' of the blood can also predispose toward ACS. Recent results have established the multiplicity of 'high-risk' plaques and the widespread nature of inflammation in patients prone to develop ACS. These findings challenge our traditional view of coronary atherosclerosis as a segmental or localized disease. Thus, treatment of ACS should involve 2 overlapping phases: first, addressing the culprit lesion, and second, aiming at rapid 'stabilization' of other plaques that may produce recurrent events. The concept of 'interventional cardiology' must expand beyond mechanical revascularization to embrace preventive interventions that forestall future events.

"

Most Doctors Favor Annual Check-Ups, Evidence Notwithstanding -

Most Doctors Favor Annual Check-Ups, Evidence Notwithstanding - CME Teaching Brief - MedPage Today

# Understand the limitations of the annual physical examination and the reasons that national guidelines currently recommend against their routine practice.

# Consider the potential value of the annual physical exam as a means of strengthening the physician-patient bond.

Thresholds for normal blood pressure and serum cholesterol -- Westin and Heath 330 (7506): 1461 -- BMJ

Thresholds for normal blood pressure and serum cholesterol -- Westin and Heath 330 (7506): 1461 -- BMJ

Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: segunda-feira, 27 de junho de 2005 17:18
Assunto: Thresholds for normal blood pressure and serum cholesterol
BMJ 2005;330:1461-1462
Thresholds for normal blood pressure and serum cholesterol Lower thresholds mean that 90% of people over 50 years are identified as patients

WMA: recognition of the essential role of health professionals in tobacco control

WMA - Policy:
"WMA Council Resolution on implementation of the WHO Framework Convention on tobacco control
De: Dr. Ronald Davis [mailto:davis@globalink.org]
Enviada em: segunda-feira, 27 de junho de 2005 12:45
Assunto: WMA urges natl medical associations to support FCTC
At its meeting last month, the World Medical Association, a consortium of approximately 80 National Medical Associations, adopted the policy copied below regarding the FCTC.
Best wishes,
Ron Davis

http://www.wma.net/e/policy/cr_4.htm

Adopted at the 170th WMA Council Session, Divonne-les-Bains, France, 15 May 2005

The World Medical Association Welcomes the recognition of the essential role of health professionals in tobacco control as the focus of World No Tobacco Day, 31 May 2005;
Recognises the importance of the WHO Framework Convention on Tobacco Control (FCTC) in furthering the campaign to protect people from exposure and addiction to tobacco;
Encourages national medical associations to work assiduously and energetically to get their governments to ratify and implement the FCTC;
Urges governments to introduce regulation and other measures as set out in the FCTC. Governments should also introduce a ban on smoking in enclosed public places and work places as an urgent public health intervention;
Recognises the vital role of health professionals in public health education and in support for smoking cessation;
Commits, with the other members of the World Health Professions Alliance, to mobilise health professionals in the fight to implement the FCTC and to reduce the human cost of tobacco.

"

Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery? -- Jin et al. 111 (25): 3359 -- Circulation

Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery? -- Jin et al. 111 (25): 3359 -- Circulation
Body size is not a significant risk factor for CABG mortality, but the lowest mortality is found in the high-normal and overweight subgroups compared with obese and underweight.

Stroke epidemiology in Latin America

De: Ines Lessa [mailto:ines@lessa.org]
Enviada em: sábado, 25 de junho de 2005 17:11
Para: aloyzio.achutti
Assunto: Re: Stroke epidemiology in the developing world

Caro Dr. Achutti,
...............
Mandei e-mail para os autores que disseram não haver
qualquer informação sobre incidência de AVE na América Latina. Em 1983 o
meu foi publicado em ingles no PAHO Bulletin, embora descritivo, pois na
época as análises não eram sofisticadas como atualmente. Também existe
um estudo de incidência do AVE para a cidade de Joinville, publicado no
Brasil, mas em revista indexada. Foi um e-mail educado, só parabenizando
e dando a informação.
No proprio Lancet foi publicada uma carta que enviei, sobre os casos
encontrados de AVE por leptospirose(isso eu não referi). Esse meu
artigo foi usado por um pesquisador de Boston com mais 16 estudos com
metodologia semelhante em estudo de revisão (não foi metanálise) e
publicado. Depois que ele padronizou todos com uma mesma população
padrão, Salvador saiu com a maior incidência entre os países ocidentais.
Abraço,
Ines

Stroke epidemiology in the developing world

The Lancet
Feigin VL
One of the major problems of stroke epidemiology is the lack of good-quality epidemiological studies in developing countries. Despite over two-thirds of stroke deaths worldwide occurring in developing countries, there have been few population-based incidence studies of stroke in these populations, and none from Latin America.

A study of stroke incidence and outcomes by Pablo Lavados and colleagues in Iquique, Chile (the PISCIS Project), in today's Lancet helps to fill this gap in our knowledge. This is the first study of population-based incidence of stroke in Latin America that meets not only the standard1 but also the most rigorous criteria for an ideal study of stroke incidence.2 Completeness of case ascertainment with multiple overlapping sources of information in a relatively large study area, a high level of early verification of stroke subtypes by CT (91%), and comprehensiveness of the report are impressive and leave no doubts about the methodological soundness of the study. The key findings are that stroke outcomes and incidence rates in the predominantly Hispanic-Mestizo population of Iquique are similar to incidence rates in other populations, but the proportion of intracerebral haemorrhage was somewhat higher.

CARDIOLOGISTAS DE TODO O BRASIL CONSTERNADOS PELA MORTE DE EDSON SAAD

Sócios: Notícias
(Fonte ABC)
O falecimento, no dia 3 de junho, do professor Edson A. Saad, sensibilizou os cardiologistas do Brasil inteiro, muitos dos quais se iniciaram na profissão através dos seus ensinamentos. A SBC convida a todos para a missa de sétimo dia, que será celebrada nesta sexta-feira, 10 de junho, às 18 horas, na igreja de São José, à avenida Borges de Medeiros, 2.735, na lagoa Rodrigo de Freitas.

Saad, que nasceu em Igarapava, no Estado de São Paulo, prestou inestimáveis serviços à SBC, principalmente no setor da Educação Continuada, e seus artigos sobre hipertensão arterial e aterosclerose, sempre muito didáticos, ajudaram o desenvolvimento de centenas de cardiologistas.

Professor de duas Universidades, a Federal do Rio de Janeiro e a UFF, de Niterói, Edson Saad era membro da Academia Nacional de Medicina.

Casado com d. Mônica Benchimol Saad há quase 43 anos, deixa três filhos, um dos quais, Eduardo, seguiu os passos do pai e tornou-se cardiologista, especializando-se em arritmias. Edson Saad deixa também oito netos.

PLAC Test – The Test for Lp-PLA2 – Website

PLAC Test – The Test for Lp-PLA2 – Website
Focus on Prevention

The PLACTM test can help physicians identify patients at high risk for ischemic stroke or coronary heart disease. When used in conjunction with clinical evaluation and traditional risk assessment, the PLAC test can provide more accurate ischemic stroke and cardiac risk estimates to aid in determining the most appropriate treatment strategies to prevent stroke and heart disease.
The PLAC Test Advances Stroke and CHD Prevention

* The PLAC test is the only FDA-cleared blood test to aid in determining the risk for ischemic stroke associated with atherosclerosis
* Elevated Lp-PLA2 doubles an individual's risk of experiencing an ischemic stroke or coronary event, independent of traditional risk factors
* Lp-PLA2 is additive to blood pressure in predicting future incident ischemic stroke
* Major clinical studies have shown Lp-PLA2 to be highly predictive of cardiovascular risk
* The PLAC test provides accurate, reliable results that you can trust to identify your patients who may be at an elevated risk for a future ischemic stroke or coronary event

With a clear picture of your patient's cardiovascular risk, you can more accurately determine what type of goals and treatment programs your patient will need to minimize the risk of having a major cardiovascular event.

The Lancet call for papers on the global burden of chronic diseases

Greetings,
The June 4 issue of The Lancet issued a call for papers on the global burden of chronic diseases (see "Comment" reprinted below). I invite members of the ProCOR network to submit original research papers on the following
themes:
--Consequences of the unchecked increase in chronic disease for individuals and societies. --The case for urgent national and global action to prevent and control the rising burden of chronic disease. --Effective and feasible interventions within the context of an incremental, integrated approach to chronic disease prevention and control. --Work from China and India on their challenges and progress towards the prevention and control of chronic diseases.

I encourage members of the ProCOR network to submit contributions in order to strengthen this special series.

The deadline for submission of research articles is Aug 1, 2005. For more information visit www.thelancet.com or email editorial@thelancet.com

Richard Horton, Editor, The Lancet
Member, ProCOR International Advisory Council

---------------------------------
The Lancet
Volume 365, Issue 9475 , 4 June 2005-10 June 2005, Pages 1913-1914
Comment: Chronic diseases of adults-a call for papers

Robert Beaglehole (a), and Richard Horton (b)

(a)Chronic Diseases and Health Promotion, WHO, CH-1211 Geneva 27, Switzerland (b)The Lancet, London NW1 7BY, UK

This week The Lancet issues a call for papers on the global burden of chronic diseases. The Millennium Development Goals have rightly focused attention on the plight of the world's poorest children and mothers, and on select infectious disease epidemics. By contrast, chronic diseases-the leading cause of adult mortality in all regions of the world-are not yet on the international health agenda.

This year there will be about 60 million deaths worldwide. Approximately 35 million (60% of the total) will be due to chronic diseases of adults, principally heart disease, stroke, cancer, and diabetes. Approximately 16 million will occur in people younger than 70 years of age. These diseases are responsible for about 30% of the global burden of disease as measured by disability adjusted life years lost.

Many countries that have limited financial resources and poor health systems are facing an upsurge of chronic diseases. Four out of five chronic disease deaths occur in low-income and middle-income countries; one third of all cardiovascular disease deaths occur in India and China. Alarmingly, in transition countries such as Russia, chronic disease death rates are especially high in middle-aged people, causing major adverse consequences to the economies of families and societies.1

The chronic disease epidemics are driven by population ageing and social and environmental changes that increase the prevalence of common risk factors. Major initiatives are achieving some success in tobacco control, including the ratification of the WHO Framework Convention on Tobacco Control. The effects of these measures will be felt progressively, but for now, tobacco-induced epidemics are uncontrolled in most low-income and middle-income countries. The rapid transition in urbanising societies to diets that are high in fat, sugar, and salt, together with decreasing physical activity as the norm, have led to the global obesity pandemic. Obesity is driving the rapid rise in diabetes and may threaten future gains in life expectancy.2

To date, our response to these epidemics has been woefully inadequate. In several high-income countries, interventions have led to major improvements in the life expectancy and quality of life of middle-aged and older people. For example, death rates from coronary heart disease have fallen by up to 70% in the past three decades in Australia, New Zealand, the USA, and the UK. The challenge is to ensure that all populations, especially the most disadvantaged, benefit from effective preventive and treatment interventions.

The explanation for the global neglect of chronic disease is not straightforward but several misconceptions have contributed. Chronic diseases are held by some to be an unavoidable side-effect of social and economic development, diseases of affluence not warranting the attention of those seeking to provide aid to improve health. Others see them as the fault of individuals who make self-injurious choices, as though these were independent of society and entirely volitional. Yet others see chronic disease as an affliction of older men in high-income countries; and that the control of infectious disease epidemics should take priority in low-income and middle-income countries. All of these misconceptions can be rebutted with indisputable evidence-a third of deaths due to cardiovascular disease in the developing world occur in men and women of working age, mostly among the poor. They seriously distort the establishment of a balanced global health agenda.

The Lancet has commissioned a series of four papers on chronic diseases, to be published later this year. This series will demonstrate that the misconceptions we have described are not only fundamentally wrong but, if left unchecked, will produce dangerous results for individuals and societies alike. The series will make the case for urgent national and global action to prevent and control the rising burden of chronic disease and present a guide to effective and feasible interventions within the context of a stepwise, integrated approach to chronic disease prevention and control. In addition, this series will showcase work from China and India on their challenges and progress towards the prevention and control of chronic diseases.

We want to strengthen this series by publishing original research papers in each of the four issues devoted to the commissioned reviews. The deadline for submission of research articles is Aug 1, 2005.

We declare that we have no conflict of interest.
References
1 S Leeder, S Raymond and H Greenberg, A Race Against Time, Columbia University, New York (2004). 2 SJ Olshansky, DJ Passaro and RC Hershow et al., A potential decline in life expectancy on the United States in the 21st century, N Engl J Med 352 (2005), pp. 1138-45.

_____________________________________________________________________

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Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults -- Sutton-Tyrrell

Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults -- Sutton-Tyrrell et al., 10.1161/CIRCULATIONAHA.104.483628 -- Circulation: "Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults
Kim Sutton-Tyrrell DrPH*, Samer S. Najjar MD, Robert M. Boudreau PhD, Lakshmi Venkitachalam MPhil, Varant Kupelian MS, Eleanor M. Simonsick PhD, Richard Havlik MD, Edward G. Lakatta MD, Harold Spurgeon PhD, Stephen Kritchevsky MD, Marco Pahor MD, Douglas Bauer PhD, Anne Newman MD, for the Health ABC Study

From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (K.S.-T., R.M.B., L.V., V.K., A.N.); Gerontology Research Center (S.S.N., E.M.S., E.G.L., H.S.) and Laboratory of Epidemiology, Demography and Biometry (R.H.), National Institute on Aging, Bethesda, Md; University of Tennessee, Memphis (S.K.); Wake Forest University School of Medicine, Winston-Salem, NC (M.P.); and Prevention Sciences Group, University of California, San Francisco (D.B.).

* To whom correspondence should be addressed. E-mail: Tyrrell@edc.pitt.edu.

Background--Aging results in vascular stiffening and an increase in the velocity of the pressure wave as it travels down the aorta. Increased aortic pulse wave velocity (aPWV) has been associated with mortality in clinical but not general populations. The objective of this investigation was to determine whether aPWV is associated with total and cardiovascular (CV) mortality and CV events in a community-dwelling sample of older adults.

Methods and Results--aPWV was measured at baseline in 2488 participants from the Health, Aging and Body Composition (Health ABC) study. Vital status, cause of death and coronary heart disease (CHD), stroke, and congestive heart failure were determined from medical records. Over 4.6 years, 265 deaths occurred, 111 as a result of cardiovascular causes. There were 341 CHD events, 94 stroke events, and 181 cases of congestive heart failure. Results are presented by quartiles because of a threshold effect between the first and second aPWV quartiles. Higher aPWV was associated with both total mortality (relative risk, 1.5, 1.6, and 1.7 for aPWV quartiles 2, 3, and 4 versus 1; P=0.019) and cardiovascular mortality (relative risk, 2.1, 3.0, and 2.3 for quartiles 2, 3, and 4 versus 1; P=0.004). aPWV quartile was also significantly associated with CHD (P=0.007) and stroke (P=0.001). These associations remained after adjustment for age, gender, race, systolic blood pressure, known CV disease, and other variables related to events.

Conclusions--Among generally healthy, community-dwelling older adults, aPWV, a marker of arterial stiffness, is associated with higher CV mortality, CHD, and stroke.

Key words: aging • elasticity • epidemiology • mortality • risk factor"

Guidant Recalls 38,000 Defibrillators

Teaching Brief - MedPage Today
INDIANAPOLIS, June 17-The Guidant Corp. here has agreed with the FDA to recall 38,000 potentially flawed implanted heart defibrillators, the company said today.

The recalled models are the Prizm 2 DR, the Contak Renewal and Contak Renewal 2, the Ventak Prizm AVT, Vitality AVT, Renewal 3 AVT and Renewal 4 AVT ICDs.

The company said that it was voluntarily advising physicians "about important safety information regarding certain devices." These actions the FDA defined as recalls, Guidant said.

Common Stomach Bug May Affect Heart Rhythm, Study Finds

Bloomberg.com: U.K.
(Recommended by Mario Maranhao)
June 16 (Bloomberg) -- A stomach bug that affects about half of the people over the age of 60 in the U.S. may trigger an irregular heart rhythm, according to a study in the medical journal Heart, the first time such a link has been made.

Patients with an irregular heart beat, or atrial fibrillation, were 20 times more likely to test positive for Helicobacter pylori bacteria and had five times higher levels of gastric inflammation than healthy volunteers, the study of 104 people found.

Cardiosource

Cardiosource
(Recommended by Mario Maranhao)
Cardiovascular Diseases News from the American College of Cardiology

Heart Drug for Blacks Endorsed

Heart Drug for Blacks Endorsed
By Rob Stein Washington Post Staff Writer Friday, June 17, 2005; A01
(Recommended by Darcy R. Lima & Mario C. Maranhao)

Federal health advisers yesterday endorsed the approval of a drug to treat heart failure in African Americans, which would make the controversial pill the first medicine targeted at a specific racial group.

The Food and Drug Administration advisory panel voted unanimously to recommend that the agency approve a request by NitroMed Inc. of Lexington, Mass., to sell the drug BiDil for patients with severe heart failure, and a majority agreed with the company that its label should say it is specifically intended for African Americans. The agency is not bound by the panel's decision but usually follows the advice.

The closely watched vote marked a crucial step for the drug, which has triggered intense debate, coming amid intensifying efforts to tailor "personalized" treatments to the genetic makeup of individual patients and groups of patients. Supporters say the drug would represent one of the first steps in that direction, offering an urgently needed treatment to a group that suffers more from many health problems and has been long neglected by medical research. (more)

Doctors fight over drug firm influence - The Boston Globe

Doctors fight over drug firm influence - The Boston Globe - Boston.com - Business
By Christopher Rowland, Globe Staff | June 16, 2005 crowland@globe.com
(Recommended by Mario Maranhao)

A fierce, behind-the-scenes battle over how much influence drug companies exert on doctors is raising the blood pressure at the American Society of Hypertension.

The society's cofounder and longtime editor of the prestigious American Journal of Hypertension, Dr. John H. Laragh, has accused ''academic physician/businessmen" who accept industry speaking and consulting fees of improperly coloring the group's activities.

''The lines separating marketing from education have been fractured," Laragh wrote in an e-mail message to physicians in the 3,000-member society.
The episode is a stark example of a broader debate taking place within the nation's medical societies, which represent physicians in virtually every medical specialty. Recently, many of the groups have become more sensitive to the potential for conflicts of interest relating to pharmaceutical industry grants.

Disagreements have flared over industry money used to support the hypertension society's educational programs, as well as the propriety of direct industry payments to physicians who serve as lecturers and consultants. The hypertension organization requires doctors participating in speaking programs to reveal the payments, but does not require them to disclose amounts.

Critics say the payments help companies put a patina of scientific and medical legitimacy on what is otherwise an attempt to increase market share.

''The society is seen as sort of a marketing tool by industry. There is a lot of money to go around," said Dr. Curt D. Furberg, a former member of its executive council and a professor of public health sciences at Wake Forest University in North Carolina.

The stakes for the drug companies are especially high in disease areas like hypertension, where the potential markets are huge (about 60 million Americans have high blood pressure) and where doctors can prescribe among a variety of competing brand-name drugs with similar characteristics.

''Every society that I know of is doing a lot of soul-searching in the area of conflict of interest and ethical responsibilities," said Paul Pomerantz, president of the American Association of Medical Society Executives.

Laragh leveled his charges a week before the society's annual gathering May 14-18 in San Francisco. The move by Laragh, a respected pioneer in hypertension research and a professor at Cornell University's Weill Medical College in New York, highlighted a split in the organization between a group of physicians that expresses wariness about industry participation and a newer faction that embraces it.

The dispute has now spread from the American Society of Hypertension to its official journal, the American Journal of Hypertension, which Laragh controls. He has closed the journal's office, which was located in the same Manhattan office suite as the society, and moved it to a sympathetic colleague's office at the Albert Einstein College of Medicine of Yeshiva University in the Bronx.

The society's president, Dr. Thomas Giles, a professor of medicine at Louisiana State University, said he hopes to repair the rift between the journal and the society. He denied Laragh's charge that drug companies have improperly influenced the society's activities under his watch.

Industry sponsorships of meetings and their payments to doctors, Giles said, are part of a ''partnership" between physicians, corporations, and government and can be managed with appropriate disclosure rules. The society estimates that about $1.5 million of its $4.4 million annual budget is met by ''unrestricted educational grants" by drug companies. Among the large sponsors of this year's annual meeting in San Francisco were Novartis AG, AstraZeneca Pharmaceuticals LP, and Pfizer Inc.

''We will not put ourselves in the position where were are going to function as the marketing arm for anybody," Giles said. ''All academicians who are prominent are asked to give talks. To characterize their efforts as marketing is clearly not correct."

The drug companies say they spend money on grants to medical societies because it helps get news out to doctors about medical advances.

''We think it is important for scientific organizations to continue to provide forums in which important information and research is shared," said Carla Burigatto, a spokeswoman at AstraZeneca.

The disagreement has taken on the characteristics of a political mud fight. Laragh's enemies have questioned the size of his American Journal of Hypertension salary -- $229,000 in 2003 -- and whether he engineered the selection of his wife, Jean E. Sealey, as the society's president-elect. Sealey is a leading hypertension researcher, but she is not a medical doctor. Giles formed a committee last year that investigated the salary level and found that it ''substantially exceeded" the salaries paid by other medical journals, but he declined to discuss the issue in an interview.

Laragh, responding for himself and his wife, dismissed those issues as ''low blows." He said this week that the real issue was the drug companies' presence and participation at the society's meeting in San Francisco, which he said reached levels never seen in the history of the 19-year-old society. Previously, industry-sponsored education sessions were confined to ''satellite" sessions before and after the society's events. This year, Laragh said, the sessions were intertwined with the rest of the program. The main speaking sessions each day, he said, were sponsored by different drug companies, also for the first time.

Among the doctors he singled out for criticism in his e-mail, alleging that personal business interests were intermingled with society proceedings, was Dr. Michael A. Weber, a leading figure and past president of the society. Weber once conducted research with Laragh and is a professor at the Downstate College of Medicine at the State University of New York.

Weber also is a founding partner of a company in New York, Integrium LLC, which administers clinical trials under contract with pharmaceutical companies. Individual researchers were once limited to one speaking opportunity at the annual meeting, Laragh said, but this year Weber and physicians affiliated with Integrium were given seven chances to speak. At one session, an Integrium physician chaired a meeting to discuss results of a clinical trial of Avapro that Integrium administered. Avapro is a hypertension drug marketed jointly by Bristol-Myers Squibb Co. and Sanofi-Aventis SA.

Weber defended the role that Integrium, Bristol-Myers Squibb, and Sanofi-Aventis played. He said the physicians associated with Integrium did not interpret or disseminate results of the trial.

All medical societies rely heavily on industry sponsorship, Weber said. ''Otherwise we wouldn't exist," he said.

Should everyone over 50 take aspirin prophylaxis? -- 330 (7505): 0 -- BMJ

Should everyone over 50 take aspirin prophylaxis? -- 330 (7505): 0 -- BMJ
(Recommended by:: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com] )
On pages 1440 and 1442, two sides of the argument are presented on whether aspirin should be used for primary prevention of vascular disease in all people over a certain age, and what that age should be. Elwood and colleagues believe that evidence shows that aspirin should be taken from around 50 years of age, but they also argue that the topic should be widely discussed and that the final decision should lie with each individual person. Baigent is not convinced by the available evidence and argues that such practice could result in net harm.

Lambl's Excrescences

Echocardiography
Lambl (Wein Med Wschr vi, 1856, 244) described small filiform processes on the aortic valve. Margerey (J Path Bact 1949; 61:203-208) studied 250 mitral valves and postulated that the mechanism of formation is intimal damage due to mechanical trauma at the leaflet coaptation.

The damaged area is covered by fibrin, which subsequently becomes uplifted, or partially detached from the valve surface. A layer of intimal cells covers the surface of the fibrin deposit. The enclosed fibrin becomes condensed and hyaline constituting the excrescence. Organized hyaline substance is later replaced by fibrous and elastic tissue.

Heart Valve Society of America

Heart Valve Society of America
HVSA (including the Heart Valve Trialists Society) was founded by a group of nationally and internationally recognized American experts in heart valve diseases to advance recognition and knowledge of the field.

HVSA will:

* promote research;
* educate medical professionals about the evaluation and treatment of heart valve diseases;
* serve as an informational resource for government, private industry, healthcare providers, the media and public; and,
* encourage and facilitate education of future heart valve disease specialists.