Coronary Heart Disease (CHD)—One or Several Diseases

Maria Inês Azambuja* and Richard Levins†

ABSTRACT
In retrospect, mortality from coronary heart disease (CHD) in the 20th century followed an epidemic pattern: mortality rates increased dramatically from 1920 until about 1960, remained roughly constant for almost a decade, and have been decreasing since the late 1960s. CHD has traditionally been conceived of as a single disease with multifactorial causality.We suggest instead that CHD cases may comprise at least two distinct populations: those associated with hypercholesterolemia, and those associated with insulin resistance.The epidemic of CHD was due primarily to changes in the incidence of the hypercholesterolemia subgroup.We propose that young adults who survived the 1918 influenza pandemic were rendered vulnerable to lipid-associated CHD and coronary thrombosis upon reinfection with influenza later in life.This
vulnerability may be due to autoimmune disruption of low-density lipoprotein-receptor
interactions. Historical events may affect the health of populations by affecting the susceptibility of populations to chronic diseases such as CHD. The life experiences of individuals are known to influence their susceptibility to infectious diseases; we suggest that life experiences may also influence individual susceptibility to chronic diseases.
*Graduate Program of Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.To whom correspondence should be addressed.
†School of Public Health, Harvard University.
E-mail: miazambuja@terra.com.br.
Perspectives in Biology and Medicine, volume 50, number 2 (spring 2007):228–42 © 2007 by The Johns Hopkins University Press

GRIPE

GRIPE (artigo enviado para o jornal ZH que provavelmente não será publicado)
Aloyzio Achutti

Com o início da campanha de vacinação contra a gripe tem se falado muito sobre o assunto, mas algumas considerações e informações adicionais podem ser de interesse geral.
Está escrito e todo o mundo sabe que o grande motivo para adotar medidas preventivas contra a gripe são as pneumonias e o desequilíbrio do equilíbrio instável de organismos já debilitados por outras doenças ou pela idade. Entretanto pouca gente sabe que também o comprometimento circulatório, especialmente das artérias (particularmente as do coração, podendo ocasionar infarto) é um motivo a mais e, quem sabe, ainda mais sério, conforme estudos relativamente recentes.
Aproveitando para lustrar também a prata da casa, uma pesquisadora nossa conterrânea, professora da UFRGS, tem sido reconhecida internacionalmente por ter estudado as evidências da relação das epidemias de gripe com a epidemiologia da doença das coronárias (M.I.Azambuja). A ascensão e depois a queda das doenças do coração podem ser relacionadas com a evolução dos sobreviventes da Gripe Espanhola marcados pelo vírus em suas artérias. O esgotamento desta coorte de pessoas, e não somente a redução de gorduras na alimentação e o efeito de remédios, é uma das explicações mais atuais e desafiadoras, mexendo com a cardiologia, a epidemiologia e os estudiosos de doenças crônicas.
Hoje, para classificar doenças do coração e outras crônicas, tem se evitado o uso da expressão “doenças não transmissíveis e degenerativas” em oposição às doenças “infecto-contagiosas”. A idéia de que arterioesclerose seria mera conseqüência do desgaste orgânico foi abandonada desde que se demonstrou nas lesões vasculares a existência de processo inflamatórios, precipitados ou exacerbados por infecções assim como a gripe, pneumonia, infecção periodontal ou qualquer outra infecção ou inflamação.
Portanto vacinar contra a gripe também serve para prevenir o infarto. Extremar as medidas de higiene, evitar o aperto de mãos, utilizar máscara quando gripado ou durante uma epidemia de gripe, não é esquisitice de japonês; e utilizar o lenço ao tossir ou espirrar não é somente um gesto de boa educação, mas serve para impedir a propagação do vírus e para evitar a gripe e suas complicações, até infarto...

Long term effects of dietary sodium reduction on cardiovascular disease outcomes

Nancy R Cook, associate professor¹, Jeffrey A Cutler, former senior scientific adviser², Eva Obarzanek, research nutritionist², Julie E Buring, professor¹, Kathryn M Rexrode, assistant professor of medicine¹, Shiriki K Kumanyika, professor of epidemiology³, Lawrence J Appel, professor of medicine⁴, Paul K Whelton, president and chief executive officer⁵

Correspondence to: N Cook ncook@rics.bwh.harvard.edu

Abstract

Abstract
Introduction
Methods
Results
Discussion
References

Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II.

Design Long term follow-up assessed 10-15 years after the original trial.

Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone.

Participants Adults aged 30-54 years with prehypertension.

Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II).

Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death).

Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34).

Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.

Exercise and Acute Cardiovascular Events.

Paul D. Thompson MD, FAHA, Co-Chair, Barry A. Franklin PhD, FAHA, Co-Chair, Gary J. Balady MD, FAHA, Steven N. Blair PED, FAHA, Domenico Corrado MD, PhD, N. A. Mark Estes III MD, FAHA, Janet E. Fulton PhD, Neil F. Gordon MD, PhD, MPH, William L. Haskell PhD, FAHA, Mark S. Link MD, Barry J. Maron MD, Murray A. Mittleman MD, FAHA, Antonio Pelliccia MD, Nanette K. Wenger MD, FAHA, Stefan N. Willich MD, FAHA, and Fernando Costa MD, FAHA

Abstract--Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.

Trat. intensivo vs moderado con Estatinas:Metaanálisis-JAmCollCardiol2006_438-45

Referred by: Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
The purpose of this study was to conduct a meta-analysis that compares the reduction of
cardiovascular outcomes with high-dose statin therapy versus standard dosing.
BACKGROUND Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.
METHODS We searched PubMed and article references for randomized controlled trials of intensive versus standard-dose statin therapy enrolling more than 1,000 patients with either stable coronary heart disease or acute coronary syndromes. Four trials were identified: the TNT (Treating to New Targets) and the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering) trials involved patients with stable cardiovascular disease, and the PROVE IT–TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–
Thrombolysis in Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor) trials involved
patients with acute coronary syndromes. We carried out a meta-analysis of the relative odds on the basis of a fixed-effects model using the Mantel-Haenszel method for the major outcomes of death and cardiovascular events.
RESULTS A total of 27,548 patients were enrolled in the 4 large trials. The combined analysis yielded a significant 16% odds reduction in coronary death or myocardial infarction (p
0.00001), as well as a significant 16% odds reduction of coronary death or any cardiovascular event (p
0.00001). No difference was observed in total or non-cardiovascular mortality, but a trend toward decreased cardiovascular mortality (odds reduction 12%, p 0.054) was observed.
CONCLUSIONS Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events. (J Am Coll Cardiol 2006;48:438–45) © 2006 by the American College of Cardiology Foundation

Guidelines for Acute Coronary Syndromes Benefit the Old Old

BOSTON, April 26 -- Patients 90 or older with acute coronary syndromes have decreased hospital mortality when recommended therapy guidelines are followed, according to researchers here.
So-called old-old patients who arrived at an emergency room with non-ST-segment elevation acute coronary syndromes were less likely than younger elderly patients, ages 75 to 89, to receive recommended treatments, but for those who did, survival was better, reported the CRUSADE team in the May 1 issue of the Journal of the American College of Cardiology.
The CRUSADE registry, used in this study, is an ongoing voluntary, observational quality-improvement initiative for patients with non-ST-segment elevation acute coronary syndrome, said David J. Cohen, M.D., of Beth Israel Deaconess Medical Center, and colleagues.
The researchers used the CRUSADE registry data to study 5,557 patients, age 90 and older, with acute coronary syndromes, seen in emergency rooms at 525 hospitals. Of these, 112 patients were 100 years or older. Patients were enrolled from January 2001 through June 2005.

COURAGE Embargo Break: Slip of the Tongue or Sabotage?

http://www.medpagetoday.com/Cardiology/PCI/dh/5498
NEW YORK -- A leading light in interventional cardiology -- Martin B. Leon, M.D., of Columbia University -- may have leaked details of a major study weeks before it was scheduled to release.

A MedPage Today investigation uncovered a pattern of leaks by Dr. Leon beginning March 7, three weeks before results of the trial were to be presented at the American College of Cardiology meeting and simultaneously published in the New England Journal of Medicine.

This breach of confidentiality involved the results of the COURAGE trial, which found that stents were essentially co-equal with medical therapy for stable angina.

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.