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.