Cardiosource: "Inflammation is now recognized as playing a fundamental role in atherosclerosis and its acute thrombotic complications.1 Although not necessarily the primary event, inflammation and cytokine activation during plaque formation and destabilization may represent a common final pathway to various stimuli. To the degree that inflammatory pathways play an important pathogenic mechanism in atherogenesis and plaque destabilization, a whole new approach to treating atherosclerosis is being proposed: immunomodulation.
Twenty years ago, the first reports were published showing the presence of activated immune cells in human atherosclerotic lesions.2 This was followed shortly thereafter by evidence that vascular cells can present antigen to T cells and that vascular cells can produce as well as respond to immune cytokines.3, 4 Several disease-associated antigens subsequently were identified, including oxidized low-density lipoprotein (oxLDL)5 and heat shock protein (HSP)-60.6 This led to various hypotheses regarding the role of immune/inflammatory mechanisms in atherosclerosis.
Today, it is clear that immune cells dominate early atherosclerotic lesions and their effector molecules accelerate lesion progression, ultimately leading to inflammation that can elicit acute coronary syndromes. Thus, inflammation and immunity play a key role in a number of specific cardiovascular diseases (Slide 1), presenting a long list of po"
Friday, February 17, 2006
Governo: maior pesquisa sobre hipertensão e diabetes da América Latina
http://portal.saude.gov.br/portal/aplicacoes/noticias/noticias_detalhe.cfm?co_seq_noticia=22714
Um consórcio formado por sete conceituadas instituições de ensino superior foi selecionado - por meio de chamada pública - para o desenvolvimento daquela que será a maior pesquisa da América Latina voltada à investigação das reais causas da hipertensão e diabetes no Brasil. As universidades federais de Minas Gerais (UFMG), da Bahia (UFBA), do Espírito Santo (UFES), do Rio Grande do Sul (UFRGS), além da Universidade Estadual do Rio de Janeiro (UERJ), a Universidade de São Paulo (USP) e Fundação Oswaldo Cruz (Fiocruz), começam, no próximo mês, o Estudo Multicêntrico Longitudinal em Doenças Cardiovasculares e Diabetes Mellitus (EMLDCD), também conhecido como Estudo Longitudinal de Saúde do Adulto (Elsa/Brasil).O objetivo do EMLDCD é fazer um retrato da população brasileira a partir do monitoramento de aproximadamente 15 mil pessoas pesquisadas. Elas serão recrutadas pelas instituições de pesquisa a partir de janeiro e acompanhados por 20 ou até 30 anos. A cada ano, os pacientes serão convocados para reexame da saúde. Para tanto, o governo federal - por meio dos ministérios da Saúde e da Ciência e Tecnologia, e também da Financiadora de Estudos e Projetos (Finep) - investirá R$ 22,6 milhões na pesquisa, recursos que serão suficientes para o financiamento dos estudos nos anos de 2006, 2007 e 2008. Metade desses recursos vem do Fundo Nacional de Saúde (FNS) e a outra parte do Fundo Setorial CT-Saúde.
Um consórcio formado por sete conceituadas instituições de ensino superior foi selecionado - por meio de chamada pública - para o desenvolvimento daquela que será a maior pesquisa da América Latina voltada à investigação das reais causas da hipertensão e diabetes no Brasil. As universidades federais de Minas Gerais (UFMG), da Bahia (UFBA), do Espírito Santo (UFES), do Rio Grande do Sul (UFRGS), além da Universidade Estadual do Rio de Janeiro (UERJ), a Universidade de São Paulo (USP) e Fundação Oswaldo Cruz (Fiocruz), começam, no próximo mês, o Estudo Multicêntrico Longitudinal em Doenças Cardiovasculares e Diabetes Mellitus (EMLDCD), também conhecido como Estudo Longitudinal de Saúde do Adulto (Elsa/Brasil).O objetivo do EMLDCD é fazer um retrato da população brasileira a partir do monitoramento de aproximadamente 15 mil pessoas pesquisadas. Elas serão recrutadas pelas instituições de pesquisa a partir de janeiro e acompanhados por 20 ou até 30 anos. A cada ano, os pacientes serão convocados para reexame da saúde. Para tanto, o governo federal - por meio dos ministérios da Saúde e da Ciência e Tecnologia, e também da Financiadora de Estudos e Projetos (Finep) - investirá R$ 22,6 milhões na pesquisa, recursos que serão suficientes para o financiamento dos estudos nos anos de 2006, 2007 e 2008. Metade desses recursos vem do Fundo Nacional de Saúde (FNS) e a outra parte do Fundo Setorial CT-Saúde.
Tuesday, February 07, 2006
EPIDAT
EPIDAT: "Epidat 3.1: Análise epidemiolóxico de datos tabulados
Novidade: Epidat 3.1 disponible dende o 19 de xaneiro de 2006! Esta versión corrixe certos erros detectados na versión 3.0, e está disponible en varios idiomas.
Programa desenvolvido polo Servizo de Epidemioloxía da Dirección Xeral de Saúde Pública da Consellería de Sanidade (Xunta de Galicia) en colaboración coa Unidad de Análisis de Salud y Sistemas de Información Sanitaria da Organización Panamericana de la Salud (OPS-OMS), a través da carta de entendemento existente entre a Consellería de Sanidade e a OPS-OMS.
Nota
Epidat 3.1 és un programa de libre distribución, polo que, non só se permite, senon que se agradece a sua difusión e calquer tipo de crítica ou comentario que axude a mellorar futuras versions. "
Novidade: Epidat 3.1 disponible dende o 19 de xaneiro de 2006! Esta versión corrixe certos erros detectados na versión 3.0, e está disponible en varios idiomas.
Programa desenvolvido polo Servizo de Epidemioloxía da Dirección Xeral de Saúde Pública da Consellería de Sanidade (Xunta de Galicia) en colaboración coa Unidad de Análisis de Salud y Sistemas de Información Sanitaria da Organización Panamericana de la Salud (OPS-OMS), a través da carta de entendemento existente entre a Consellería de Sanidade e a OPS-OMS.
Nota
Epidat 3.1 és un programa de libre distribución, polo que, non só se permite, senon que se agradece a sua difusión e calquer tipo de crítica ou comentario que axude a mellorar futuras versions. "
CVD Risk reduction in Diabetes
This is a call for applications for Proposal Development Grants (PDGs) in the area of research related to cardiovascular risk reduction in diabetes, to be conducted in developing country settings. The Initiative for Cardiovascular Health Research in Developing Countries (IC Health) will provide upto 5 grants of USD 10,000 each to developing country investigators for developing detailed research project proposals, in prioritized areas indicated in the call for applications. These applications have to be submitted by 31st January 2006, in the format prescribed by IC Health.
Blood Glucose Predictive Role
Contribution from: Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
American Journal of Epidemiology 2006;163(4):342-351
The Predictive Role of Blood Glucose for Mortality in Subjects with Cardiovascular Disease
Sidney C. Port1,2, Noel G. Boyle3, Willa A. Hsueh4, Manuel J. Quiñones4, Robert I. Jennrich2 and Mark O. Goodarzi5
Using the Framingham Heart Study data (United States, 1948–1978), the authors examined the association of blood glucose with 2-year all-cause, cardiovascular, and noncardiovascular mortality in subjects with documented cardiovascular disease. After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality. However, the relations for men and women were qualitatively different. For men, adjusted mortality risk increased very rapidly through the normal range (from 4.12% at 3.89 mmol/liter (70 mg/dl) to 12.26% at 5.55 mmol/liter (100 mg/dl)) and was flat at 12.26% thereafter. For women, risk was flat at 3.65% through the normal range and then increased rapidly, reaching 8.34% at 6.99 mmol/liter (126 mg/d), but increased much more slowly thereafter. Exactly analogous relations held for cardiovascular mortality.
For men and women combined, noncardiovascular mortality increased from 1.82% at 3.89 mmol/liter to 2.06% at 5.55 mmol/liter to 2.29% at 6.99 mmol/liter (p for trend = 0.009). These findings suggest that although 5.55 mmol/liter (normal) may be a useful mortality risk division (albeit with different implications for the two sexes), 6.99 mmol/liter (diabetic) is not, especially for men.
blood glucose; cardiovascular diseases; mortality; risk factors
--------------------------------------------------------------------------------
Abbreviations: AIC, Akaike's Information Criterion; CVD, cardiovascular disease
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco
American Journal of Epidemiology 2006;163(4):342-351
The Predictive Role of Blood Glucose for Mortality in Subjects with Cardiovascular Disease
Sidney C. Port1,2, Noel G. Boyle3, Willa A. Hsueh4, Manuel J. Quiñones4, Robert I. Jennrich2 and Mark O. Goodarzi5
Using the Framingham Heart Study data (United States, 1948–1978), the authors examined the association of blood glucose with 2-year all-cause, cardiovascular, and noncardiovascular mortality in subjects with documented cardiovascular disease. After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality. However, the relations for men and women were qualitatively different. For men, adjusted mortality risk increased very rapidly through the normal range (from 4.12% at 3.89 mmol/liter (70 mg/dl) to 12.26% at 5.55 mmol/liter (100 mg/dl)) and was flat at 12.26% thereafter. For women, risk was flat at 3.65% through the normal range and then increased rapidly, reaching 8.34% at 6.99 mmol/liter (126 mg/d), but increased much more slowly thereafter. Exactly analogous relations held for cardiovascular mortality.
For men and women combined, noncardiovascular mortality increased from 1.82% at 3.89 mmol/liter to 2.06% at 5.55 mmol/liter to 2.29% at 6.99 mmol/liter (p for trend = 0.009). These findings suggest that although 5.55 mmol/liter (normal) may be a useful mortality risk division (albeit with different implications for the two sexes), 6.99 mmol/liter (diabetic) is not, especially for men.
blood glucose; cardiovascular diseases; mortality; risk factors
--------------------------------------------------------------------------------
Abbreviations: AIC, Akaike's Information Criterion; CVD, cardiovascular disease
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco
Monday, February 06, 2006
Death from Acute Rheumatic Fever in Rural Ethiopia
The Lancet: "In their Seminar, Jonathan Carapetis and colleagues (July 9, p 155)1 identify the need for more and better data on acute rheumatic fever (ARF) and rheumatic heart disease (RHD), particularly in low-income and middle-income countries. In rural Ethiopia, the prevalence of RHD in schoolchildren is about 4.6 per 10002 and recent research showed a mean age at death of 25.9 years in hospital inpatients.3
Secondary prophylaxis with a regular injection of penicillin every 3 or 4 weeks is a proven and the most cost-effective approach to the control of ARF and RHD, since primary prophylaxis is difficult to establish and vaccine development is still years away. At Dabat Health Centre in the North Gondar Administrative Zone, Ethiopia, patients with ARF and RHD have been enrolled in a follow-up and secondary prevention programme since 1998. Patients are included after seeking health care because of symptomatic ARF or RHD."
Secondary prophylaxis with a regular injection of penicillin every 3 or 4 weeks is a proven and the most cost-effective approach to the control of ARF and RHD, since primary prophylaxis is difficult to establish and vaccine development is still years away. At Dabat Health Centre in the North Gondar Administrative Zone, Ethiopia, patients with ARF and RHD have been enrolled in a follow-up and secondary prevention programme since 1998. Patients are included after seeking health care because of symptomatic ARF or RHD."
Cardiovascular Diseases Calendar
ProCOR - Home Page: "ProCOR's CVD Calendar compiles events taking place globally that are relevant to the prevention of cardiovascular disease in developing countries.
To submit information about an event to the calendar, email details to info@procor.org.
CVD Calendar
� 2006
� 2007
� Links for additional events "
To submit information about an event to the calendar, email details to info@procor.org.
CVD Calendar
� 2006
� 2007
� Links for additional events "
Thursday, January 26, 2006
Early detection of cardiovascular disease - the future of cardiology?
E-Journal - Volume 4 - vol4n19: "Early detection of cardiovascular disease - the future of cardiology?
Prof. D. Duprez . Minneapolis, United States of America. Past-Chairman of the ESC Working Group on Peripheral Circulation
Recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
Our goal is to improve the precision for early detection and treatment of cardiovascular disease by identifying markers for early disease and the response to therapy. The traditional approach to cardiovascular disease prevention involves identifying risk factors that are statistically but not necessarily biologically related to disease. Health care expenditures are overwhelming national and corporate budgets, predominantly because of the escalating costs of advanced disease. Therefore there is an urgent need for early detection and treatment of asymptomatic cardiovascular disease."/.../
Prof. D. Duprez . Minneapolis, United States of America. Past-Chairman of the ESC Working Group on Peripheral Circulation
Recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
Our goal is to improve the precision for early detection and treatment of cardiovascular disease by identifying markers for early disease and the response to therapy. The traditional approach to cardiovascular disease prevention involves identifying risk factors that are statistically but not necessarily biologically related to disease. Health care expenditures are overwhelming national and corporate budgets, predominantly because of the escalating costs of advanced disease. Therefore there is an urgent need for early detection and treatment of asymptomatic cardiovascular disease."/.../
Early Invasive versus Selectively Invasive Management
Recomendado por Nelson Robson & Carmem [nelcarmem@uol.com.br]
(Full document available on request)
n engl j med 353;11 www.nejm.org september 15, 2005
Background
Current guidelines recommend an early invasive strategy for patients who have acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level. However, randomized trials have not shown an overall reduction in mortality, and the reduction in the rate of myocardial infarction in previous trials has varied depending on the definition of myocardial infarction.
methods
We randomly assigned 1200 patients with acute coronary syndrome without ST-segment elevation who had chest pain, an elevated cardiac troponin T level (≥0.03μg per liter), and either electrocardiographic evidence of ischemia at admission or a documented history of coronary disease to an early invasive strategy or to a more conservative (selectively invasive) strategy. Patients received aspirin daily, enoxaparin for 48 hours, and abciximab at the time of percutaneous coronary intervention. The use of clopidogrel and intensive lipid-lowering therapy was recommended. The primary end point was a composite of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms within one year after randomization.
results
The estimated cumulative rate of the primary end point was 22.7 percent in the group assigned to early invasive management and 21.2 percent in the group assigned to selectively invasive management (relative risk, 1.07; 95 percent confidence interval, 0.87 to 1.33; P=0.33). The mortality rate was the same in the two groups (2.5 percent).
Myocardial infarction was significantly more frequent in the group assigned to early invasive management (15.0 percent vs. 10.0 percent, P=0.005), but rehospitalization was less frequent in that group (7.4 percent vs. 10.9 percent, P=0.04).
conclusions
We could not demonstrate that, given optimized medical therapy, an early invasive strategy was superior to a selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level.
(Full document available on request)
n engl j med 353;11 www.nejm.org september 15, 2005
Background
Current guidelines recommend an early invasive strategy for patients who have acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level. However, randomized trials have not shown an overall reduction in mortality, and the reduction in the rate of myocardial infarction in previous trials has varied depending on the definition of myocardial infarction.
methods
We randomly assigned 1200 patients with acute coronary syndrome without ST-segment elevation who had chest pain, an elevated cardiac troponin T level (≥0.03μg per liter), and either electrocardiographic evidence of ischemia at admission or a documented history of coronary disease to an early invasive strategy or to a more conservative (selectively invasive) strategy. Patients received aspirin daily, enoxaparin for 48 hours, and abciximab at the time of percutaneous coronary intervention. The use of clopidogrel and intensive lipid-lowering therapy was recommended. The primary end point was a composite of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms within one year after randomization.
results
The estimated cumulative rate of the primary end point was 22.7 percent in the group assigned to early invasive management and 21.2 percent in the group assigned to selectively invasive management (relative risk, 1.07; 95 percent confidence interval, 0.87 to 1.33; P=0.33). The mortality rate was the same in the two groups (2.5 percent).
Myocardial infarction was significantly more frequent in the group assigned to early invasive management (15.0 percent vs. 10.0 percent, P=0.005), but rehospitalization was less frequent in that group (7.4 percent vs. 10.9 percent, P=0.04).
conclusions
We could not demonstrate that, given optimized medical therapy, an early invasive strategy was superior to a selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level.
Wednesday, January 25, 2006
Erectile Dysfunction Predicts Coronary Heart Disease - CME Teaching Brief - MedPage Today
Erectile Dysfunction Predicts Coronary Heart Disease - CME Teaching Brief - MedPage Today:
Min JK et al. Prediction of Coronary Heart Disease by Erectile Dysfunction in Men Referred for Nuclear Stress Testing. Arch Intern Med. 2006;166:201-206.
"Consider questioning men about sexual function when treating them for suspected coronary heart disease, noting that this study implies erectile dysfunction is an independent predictor of severe disease, at least among men referred for stress testing.
Advise patients that erectile dysfunction has been demonstrated to share a common profile of risk factors with coronary artery disease that includes diabetes, hypertension, cigarette smoking, and hyperlipidemia.
Note that further studies are needed to establish whether patients with erectile dysfunction but no cardiac symptoms should be screened for overt coronary heart disease. /.../"
Min JK et al. Prediction of Coronary Heart Disease by Erectile Dysfunction in Men Referred for Nuclear Stress Testing. Arch Intern Med. 2006;166:201-206.
"Consider questioning men about sexual function when treating them for suspected coronary heart disease, noting that this study implies erectile dysfunction is an independent predictor of severe disease, at least among men referred for stress testing.
Advise patients that erectile dysfunction has been demonstrated to share a common profile of risk factors with coronary artery disease that includes diabetes, hypertension, cigarette smoking, and hyperlipidemia.
Note that further studies are needed to establish whether patients with erectile dysfunction but no cardiac symptoms should be screened for overt coronary heart disease. /.../"
In Coronary Surgery, Spare the Aorta to Save the Brain - CME Teaching Brief - MedPage Today
In Coronary Surgery, Spare the Aorta to Save the Brain - CME Teaching Brief - MedPage Today: "
By Peggy Peck, Managing Editor, MedPage Today
Be aware that this study suggests that it is surgical technique, not the use of a cardiopulmonary bypass pump, that increases the risk of cognitive impairment following heart surgery.
Explain to patients who ask that these findings are limited by the significant age differences between the traditional surgery arm and the two comparator groups."
By Peggy Peck, Managing Editor, MedPage Today
Be aware that this study suggests that it is surgical technique, not the use of a cardiopulmonary bypass pump, that increases the risk of cognitive impairment following heart surgery.
Explain to patients who ask that these findings are limited by the significant age differences between the traditional surgery arm and the two comparator groups."
Tuesday, January 17, 2006
Cardiovascular Risks of Ethos and Pathos at the Movies - CME Teaching Brief - MedPage Today
Cardiovascular Risks of Ethos and Pathos at the Movies - CME Teaching Brief - MedPage Today:
"Understand that this small study suggests that laughter can have a beneficial effect on the cardiovascular system by inducing relaxation of arterial endothelium, thereby improving circulation.
Advise patients that a good laugh has never been known to be harmful. "/.../
"Understand that this small study suggests that laughter can have a beneficial effect on the cardiovascular system by inducing relaxation of arterial endothelium, thereby improving circulation.
Advise patients that a good laugh has never been known to be harmful. "/.../
Friday, January 13, 2006
Cardiovascular Disease and Associated Risk Factors
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]. Full tex available on request
Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there.
Methods. We reviewed Cuban public health statistics, surveys, and reports of health services.
Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors.
Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. (Am J Public Health. 2006;96:94–101. doi:10.2105/AJPH.2004.051417)
Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there.
Methods. We reviewed Cuban public health statistics, surveys, and reports of health services.
Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors.
Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. (Am J Public Health. 2006;96:94–101. doi:10.2105/AJPH.2004.051417)
Thursday, January 12, 2006
International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.
International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.Authors: Bhatt DL, et al. Reviewed by: Joaquin Barnoya, MD, MPH (ProCOR)
Context
Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis.
ObjectiveTo determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world.
Design, Setting, and Participants
The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67 888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40 258; cerebrovascular disease, n = 18843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12 389) between 2003 and 2004.
Main Outcome Measures
Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control.
ResultsAtherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P< .001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for 3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease. Conclusion
This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.JAMA. 2006;295:180-189
Chronic Stable Angina and Asymptomatic CAD
Referred by: Marcelo Gustavo Colominas [mgcolominas@gigared.com]
Full text available on request.
Primary Care Management of Chronic Stable Angina and Asymptomatic Suspected or Known Coronary Artery Disease: A Clinical Practice Guideline from the American College of Physicians
Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, MPH; for the American College of Physicians/American College of Cardiology Chronic Stable Angina Panel*
In 1999, the American College of Physicians (ACP), then the American College of Physicians–American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization
procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.
Ann Intern Med. 2004;141:562-567.
Full text available on request.
Primary Care Management of Chronic Stable Angina and Asymptomatic Suspected or Known Coronary Artery Disease: A Clinical Practice Guideline from the American College of Physicians
Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, MPH; for the American College of Physicians/American College of Cardiology Chronic Stable Angina Panel*
In 1999, the American College of Physicians (ACP), then the American College of Physicians–American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization
procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.
Ann Intern Med. 2004;141:562-567.
Saturday, January 07, 2006
XXVI Congresso Norte/Nordeste de Cardiologia
XXVI Congresso Norte/Nordeste de Cardiologia:
De: Pedro Albuquerque [mailto:pfalbuquerque@uol.com.br] Enviada em: sábado, 7 de janeiro de 2006 01:24
Gostaria que fosse divulgado aos amigos da AMICOR que o XXVI Congresso Norte-Nordeste de Cardiologia e XXVIII Congresso de Ciruurgia Cardiovascular do Note-Nordeste será realizado em Maceió nos dia 8,9 e 10 de junho de 20006.
O site do congresso é http://congresso.cardiol.br/norte-nordeste, inscrições de TL online http:///tl.cardiol.br.
P.S - veja o anexo.
Muito Obrigado.
Pedro Albuquerque - presidente do congresso.
"Caros colegas cardiologistas,
Há meses as comissões Organizadoras do XXVI Congresso Norte/Nordeste de Cardiologia e do XXVIII Congresso de Cirurgia Cardiovascular Norte/Nordeste, encontram-se plenamente empenhadas no esforço de manter o alto padrão que sempre caracterizou esse megaevento, principal encontro da Cardiologia e da Cirurgia Cardiovascular dos norte/nordestinos.
Maceió prepara-se para, nos dias 8, 9 e 10 de junho de 2006, no Centro Cultural e de Exposições (Centro de Convenções), recebê-los de forma especial, mantendo-os fraternalmente acolhidos."
De: Pedro Albuquerque [mailto:pfalbuquerque@uol.com.br] Enviada em: sábado, 7 de janeiro de 2006 01:24
Gostaria que fosse divulgado aos amigos da AMICOR que o XXVI Congresso Norte-Nordeste de Cardiologia e XXVIII Congresso de Ciruurgia Cardiovascular do Note-Nordeste será realizado em Maceió nos dia 8,9 e 10 de junho de 20006.
O site do congresso é http://congresso.cardiol.br/norte-nordeste, inscrições de TL online http:///tl.cardiol.br.
P.S - veja o anexo.
Muito Obrigado.
Pedro Albuquerque - presidente do congresso.
"Caros colegas cardiologistas,
Há meses as comissões Organizadoras do XXVI Congresso Norte/Nordeste de Cardiologia e do XXVIII Congresso de Cirurgia Cardiovascular Norte/Nordeste, encontram-se plenamente empenhadas no esforço de manter o alto padrão que sempre caracterizou esse megaevento, principal encontro da Cardiologia e da Cirurgia Cardiovascular dos norte/nordestinos.
Maceió prepara-se para, nos dias 8, 9 e 10 de junho de 2006, no Centro Cultural e de Exposições (Centro de Convenções), recebê-los de forma especial, mantendo-os fraternalmente acolhidos."
Friday, January 06, 2006
The John Snow Society
The John Snow Society: "The John Snow Society aims to promote the life and works of Dr John Snow, the pioneer of epidemiological method and celebrated anaesthetist.
As outlined in the Constitution, the Society has a serious intent, publishing news, collecting facts and dates related to the life and works of John Snow and organising the Annual Pumphandle Lecture Series, but it also aims to provide a communication network for epidemiologists and those trained in the Snow tradition throughout the world.
The Society currently has over 1,000 members worldwide, many of them eminent specialists in their fields. "/.../
As outlined in the Constitution, the Society has a serious intent, publishing news, collecting facts and dates related to the life and works of John Snow and organising the Annual Pumphandle Lecture Series, but it also aims to provide a communication network for epidemiologists and those trained in the Snow tradition throughout the world.
The Society currently has over 1,000 members worldwide, many of them eminent specialists in their fields. "/.../
Heart Disease and Dementia
Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@gigared.com] chaco@fac.org.arAssunto: Heart Disease and Dementia
American Journal of Epidemiology 2006 163(2):135-141
Heart Disease and Dementia: A Population-based Study
Francesca Bursi1, Walter A. Rocca2,3, Jill M. Killian2, Susan A. Weston2, David S. Knopman3, Steven J. Jacobsen2 and Véronique L. Roger1,2
1 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN2 Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN3 Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
Correspondence to Dr. Véronique L. Roger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905 (e-mail: roger.veronique@mayo.edu).
There are conflicting reports on the possible positive association between coronary disease and dementia. The objectives of this study were to examine the association between coronary disease, as measured by myocardial infarction and cardiac death, and dementia in a population-based study. By use of the record-linkage system of the Rochester Epidemiology Project, 916 cases of dementia and 916 age (±1 year)- and sex-matched controls were identified in Rochester, Minnesota, between 1985 and 1994. From the same population, the authors identified all subjects who experienced a myocardial infarction (defined using standardized criteria) during the period 1979–1998. For myocardial infarction occurring prior to the index year of dementia, the authors used conditional logistic regression (case-control analysis), while for myocardial infarction and death occurring after the index year, they used competing risk survival analysis to account for informative censoring (cohort analysis). Before the index year, the odds ratio for myocardial infarction among cases with dementia compared with controls was 1.00 (95% confidence interval (CI): 0.62, 1.62; p = 1.00). After the index year, patients with dementia had a 46% decreased risk of subsequent myocardial infarction (hazard ratio = 0.54, 95% CI: 0.36, 0.82; p = 0.004) and an 18% decreased risk of cardiac death (hazard ratio = 0.82, 95% CI: 0.70, 0.95; p = 0.010). There was no evidence of a positive association between dementia and preceding myocardial infarction, while there was a decreased risk of myocardial infarction and cardiac death following dementia.
case-control studies; cohort studies; death; dementia; myocardial infarction; odds ratio; survival analysis
American Journal of Epidemiology 2006 163(2):135-141
Heart Disease and Dementia: A Population-based Study
Francesca Bursi1, Walter A. Rocca2,3, Jill M. Killian2, Susan A. Weston2, David S. Knopman3, Steven J. Jacobsen2 and Véronique L. Roger1,2
1 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN2 Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN3 Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
Correspondence to Dr. Véronique L. Roger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905 (e-mail: roger.veronique@mayo.edu).
There are conflicting reports on the possible positive association between coronary disease and dementia. The objectives of this study were to examine the association between coronary disease, as measured by myocardial infarction and cardiac death, and dementia in a population-based study. By use of the record-linkage system of the Rochester Epidemiology Project, 916 cases of dementia and 916 age (±1 year)- and sex-matched controls were identified in Rochester, Minnesota, between 1985 and 1994. From the same population, the authors identified all subjects who experienced a myocardial infarction (defined using standardized criteria) during the period 1979–1998. For myocardial infarction occurring prior to the index year of dementia, the authors used conditional logistic regression (case-control analysis), while for myocardial infarction and death occurring after the index year, they used competing risk survival analysis to account for informative censoring (cohort analysis). Before the index year, the odds ratio for myocardial infarction among cases with dementia compared with controls was 1.00 (95% confidence interval (CI): 0.62, 1.62; p = 1.00). After the index year, patients with dementia had a 46% decreased risk of subsequent myocardial infarction (hazard ratio = 0.54, 95% CI: 0.36, 0.82; p = 0.004) and an 18% decreased risk of cardiac death (hazard ratio = 0.82, 95% CI: 0.70, 0.95; p = 0.010). There was no evidence of a positive association between dementia and preceding myocardial infarction, while there was a decreased risk of myocardial infarction and cardiac death following dementia.
case-control studies; cohort studies; death; dementia; myocardial infarction; odds ratio; survival analysis
ACC/AHA Clinical Performance Measures
Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multi-faceted strategy to facilitate the process of improving clinical care. The initial phase of this effort was to create clinical practice guidelines that carefully review and synthesize available evidence to better guide patient care. Such guidelines are written in a spirit of suggesting diagnostic or therapeutic interventions for patients in most circumstances. Accordingly, significant judgment by clinicians is required to adapt these guidelines to the care of individual patients, and these guidelines can be generated with varying degrees of confidence based upon available evidence.
Occasionally, the evidence supporting a particular structural aspect or process of care is so strong that failure to perform such actions reduces the likelihood that optimal patient outcomes will occur. Creating a mechanism for quantifying these opportunities to improve the outcomes of care is an important and pressing challenge/.../
Occasionally, the evidence supporting a particular structural aspect or process of care is so strong that failure to perform such actions reduces the likelihood that optimal patient outcomes will occur. Creating a mechanism for quantifying these opportunities to improve the outcomes of care is an important and pressing challenge/.../
New diureticHeart Failure
NovaCardia - Product Focus - Drugs in Development: "KW-3902: An Innovative Therapy for CHF
In-licensed from Kyowa Hakko in August 2003, KW-3902 (intravenous) is currently in Phase II development for Congestive Heart Failure (CHF) patients undergoing diuresis. This proprietary small molecule acts as an adenosine-A1 receptor antagonist. Current therapies for CHF introduce significant medical liabilities to patients, most notably the risk of worsening kidney function, a predictor of poor outcome. KW-3902, with its novel mechanism of action, has the potential to significantly improve the management of CHF, particularly in patients with renal dysfunction."
In-licensed from Kyowa Hakko in August 2003, KW-3902 (intravenous) is currently in Phase II development for Congestive Heart Failure (CHF) patients undergoing diuresis. This proprietary small molecule acts as an adenosine-A1 receptor antagonist. Current therapies for CHF introduce significant medical liabilities to patients, most notably the risk of worsening kidney function, a predictor of poor outcome. KW-3902, with its novel mechanism of action, has the potential to significantly improve the management of CHF, particularly in patients with renal dysfunction."
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