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.
Thursday, January 26, 2006
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."
Thursday, January 05, 2006
Periodic Breathing in Heart Failure: Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory
Artigos na Íntegra - Merck Sharp & Dohme: Editorial do CIRCULATION de um AMICOR
"Periodic Breathing in Heart Failure: Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory [Editorial]
Ribeiro, Jorge P. MD, ScD
From the Cardiology Division, Hospital de Clínicas de Porto Alegre and Department of Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Jorge P. Ribeiro, MD, ScD, Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 90035 - 007, Porto Alegre, RS Brazil. E-mail jpribeiro@cpovo.net
In the 19th century, Cheyne 1 and Stokes 2 described a pattern of periodic breathing in patients with heart failure, but over the past few decades, particular attention has been given to the occurrence of periodic breathing during sleep.3,4 Central sleep apnea, also referred to as Cheyne-Stokes respiration, is an abnormal periodic breathing pattern in which central apneas and hypopneas alternate with periods of hyperventilation that have a waxing-waning pattern of tidal volume that classically has been associated with severe decompensated heart failure.4 Up to 37% of patients with heart failure may present obstructive sleep apnea,5 in which there is complete or partial collapse of a narrowed pharynx; as many as 40% of heart failure patients may present central sleep apnea,6 in which there is reduction in central inspiratory drive. Despite the fact that obstructive sleep apnea and central sleep apnea have different mechanisms, both are associated with increased sympathetic activity at night and during daytime that results in vasoconstriction, an increased peripheral vascular resistance.3,4 Moreover, small cohort studies had previously demonstrated that the presence of central sleep apnea is associated with increased mortality in heart failure.7,8"/.../
"Periodic Breathing in Heart Failure: Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory [Editorial]
Ribeiro, Jorge P. MD, ScD
From the Cardiology Division, Hospital de Clínicas de Porto Alegre and Department of Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Jorge P. Ribeiro, MD, ScD, Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 90035 - 007, Porto Alegre, RS Brazil. E-mail jpribeiro@cpovo.net
In the 19th century, Cheyne 1 and Stokes 2 described a pattern of periodic breathing in patients with heart failure, but over the past few decades, particular attention has been given to the occurrence of periodic breathing during sleep.3,4 Central sleep apnea, also referred to as Cheyne-Stokes respiration, is an abnormal periodic breathing pattern in which central apneas and hypopneas alternate with periods of hyperventilation that have a waxing-waning pattern of tidal volume that classically has been associated with severe decompensated heart failure.4 Up to 37% of patients with heart failure may present obstructive sleep apnea,5 in which there is complete or partial collapse of a narrowed pharynx; as many as 40% of heart failure patients may present central sleep apnea,6 in which there is reduction in central inspiratory drive. Despite the fact that obstructive sleep apnea and central sleep apnea have different mechanisms, both are associated with increased sympathetic activity at night and during daytime that results in vasoconstriction, an increased peripheral vascular resistance.3,4 Moreover, small cohort studies had previously demonstrated that the presence of central sleep apnea is associated with increased mortality in heart failure.7,8"/.../
Tuesday, January 03, 2006
Preconditioning: A New Concept About the Benefit of Exercise -- Domenech 113 (1): e1 -- Circulation
Preconditioning: A New Concept About the Benefit of Exercise -- Domenech 113 (1): e1 -- Circulation:
"Clinicians have learned about the beneficial effects of several factors that may prevent a myocardial infarction (MI), including avoidance of smoking; treatment of high blood pressure, diabetes, dyslipidemia, and obesity; and regular performance of exercise. This last factor is based on epidemiological observations such as a decrease in the incidence of MI in men who perform heavy work1,2; however, it is only in the last few years that the beneficial effect of exercise has obtained plausible explanations of its own, that is, apart from its effect on other risk factors. There are at least 3 distinct mechanisms for this benefit: (1) Improvement of endothelial function, thereby preventing atherosclerosis and coronary occlusion3; (2) prevention of remodeling after MI through the expression of oxidative metabolism-related genes4; and (3) delaying acute ischemic injury after a coronary occlusion by preconditioning. "
"Clinicians have learned about the beneficial effects of several factors that may prevent a myocardial infarction (MI), including avoidance of smoking; treatment of high blood pressure, diabetes, dyslipidemia, and obesity; and regular performance of exercise. This last factor is based on epidemiological observations such as a decrease in the incidence of MI in men who perform heavy work1,2; however, it is only in the last few years that the beneficial effect of exercise has obtained plausible explanations of its own, that is, apart from its effect on other risk factors. There are at least 3 distinct mechanisms for this benefit: (1) Improvement of endothelial function, thereby preventing atherosclerosis and coronary occlusion3; (2) prevention of remodeling after MI through the expression of oxidative metabolism-related genes4; and (3) delaying acute ischemic injury after a coronary occlusion by preconditioning. "
The Year in Cardiology, 2005 - CME Teaching Brief - MedPage Today
The Year in Cardiology, 2005 - CME Teaching Brief - MedPage Today: DALLAS, Dec. 30 - In 2005 heart disease killed more Americans than cancer, accidents or HIV infection, and it did so despite continued advances in heart disease diagnosis and treatment.
Those advances have made a dent in mortality, which declined from 322 per 100,000 in 1990 to 241 per 100,000 in 2002, but heart disease is unlikely to lose its No. 1 killer title any time soon.
The reason, authorities say, is that prevention is an elusive goal, not yet within the grasp of the cardiology's considerable reach.
For example, according to the CDC's National Center for Health Statistics, about half of America's aging baby boomers have hypertension and almost 40% are obese-a combination that is likely to spell cardiovascular mortality for many.
And yet another study found that nearly one in five Americans from the age of 12 through 49 -- an estimated 16 million -- can't pass a simple physical fitness treadmill test.
Nearing Medicare, Boomers Need Diets and Blood Pressure Control
Americans in Droves Flunk Fitness Test
While the diet-and-fitness message continues to be ignored by many Americans, researchers have been investigating mechanisms of heart disease progression as way to develop secondary prevention strategies.
Inflammation is considered a major contributor to plaque instability, which led many researchers to suggest that infection may be a trigger for cardiovascular events. And if infection could trigger an event, then antibiotics might prevent events.
That was the theory anyway, and 2005 was the year that it was debunked.
In a National Heart, Lung, and Blood Institute (NHLBI) trial, patients with stable coronary artery disease who underwent a year-long course of weekly azithromycin therapy were no less likely to have a heart attack or stroke than patients taking placebo.
Likewise, in a study sponsored by Bristol-Myers Squibb and Sankyo, acute coronary syndrome patients treated with Tequin (gatifloxacin) for a mean of two years had no reduction in cardiac events compared to patients randomized to placebo.
In announcing the negative results, NHLBI Director Elizabeth G. Nabel, M.D., said it was clear the antibiotics did not work, and it is time to focus prevention efforts on "the controllable risk factors for preventing coronary events."
No Role for Antibiotics in Cardiovascular Secondary Prevention
Another popular theory, that aggressive lipid lowering with high-dose Lipitor (atorvastatin) is better than standard therapy with Zocor (simvastatin) or other less potent statins, retained its adherents even though it was not confirmed in one major study.
That study, Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) trial, found that high dose Lipitor did not achieve a statistically significant benefit compared with usual-dose treatment with Zocor (simvastatin) in patients with a history of acute myocardial infarction.
Patients randomized to 80 mg of Lipitor had an 11% relative reduction in major coronary events versus patients randomized to 20 mg of Zocor (P=0.07).
Moreover the aggressive treatment failed to achieve a significant benefit even though high-dose Lipitor lowered LDL to 81 mg/dL versus 104 mg/dL in the Zocor group. There were no significant differences in either cardiovascular or all-cause mortality.
But those results did little to dampen the enthusiasm of many cardiologists who said they will stick to high=dose Lipitor regimens, and they have solid evidence to back up that clinical decision. In the Treating to New Targets (TNT) trial, which enrolled 10,001 patients with stable coronary disease, treatment with high-dose Lipitor to mean LDL levels of 77 mg/dL was associated with a 22% reduction in risk of major cardiovascular events compared with patients treated to a mean LDL of 101 mg/dL.
When he reported the TNT findings at the American College of Cardiology meeting in March, principal investigator John C. LaRosa, M.D., of the State University of New York Health Science Center in Brooklyn said, "We have entered a new era in the treatment of established coronary disease from starting at an LDL of 100."
AHA: High-Dose Lipitor Does Not Outdo Standard-Dose Zocor
ACC: LDL Cholesterol of Less than 80 mg/dL Reduces Risk of Heart Attack and Stroke
But a big-stick statin may not always be the safest treatment choice, according to an analysis of post-marketing safety reports from patients using Crestor (rosuvastatin), a super-potent statin, Lipitor (atorvastatin), Zocor (simvastatin), or Pravachol (pravastatin).
Patients taking Crestor were eight times more likely to develop rhabdomyolysis, nephropathy, renal failure or proteinuria than patients taking Pravachol, and 6.5 times more likely to develop those complications than patients taking Lipitor.
Richard H. Karas, M.D., Ph.D., director of preventive cardiology and the Woman's Heart Center at Tuft-New England Medical Center, noted that the absolute risk remains low: 28 events per million prescriptions for Crestor, versus 13 per million for Zocor, 3.5 per million for Pravachol, and 4.3 per million for Lipitor.
Safety and efficacy of devices was also a big issue this year, and most of the news for Guidant was bad. The device maker was forced to recall 170,000 pacemakers and implantable defibrillators, which was more than half of the company's devices. Moreover, Guidant's problems triggered a months' long series of events that included a demand by cardiologists for a reworking of device safety alerts and recalls and a two-day FDA conference on device safety.
Implantable Devices Take a Licking but Don't Always Keep on Ticking
Cardiologists Urge Changes in Safety Regs and Guidelines for ICD Use
Crestor Called Less Safe Than Other Statins
But while the year was a rocky one for the heart-device industry, it was another boom year for drug-eluting stents. These stents-Cypher, which delivers sirolimus to the endothelium and Taxus, which carries a payload of paclitaxol-now are the stents of choice for most interventionists. What remains, of course, is heavy competition between the two.
In this head-to-head race, Cypher came away as the winner in trials reported this year.
ACC: Cypher Stent Edges Ahead of Taxus in Head-to-Head Trials
ACC: Cypher Bests Taxus in All Comers Comparison Study
Just as Cypher was the odds-on-favorite in the world of stents, Plavix (clopidogrel) was this year's winner for the drug reporting the most positive trial results. It was difficult to find a cardiology journal, or a cardiology conference that didn't feature a positive Plavix study. The take home message was clear: give it early and often.
ACC: Adding Plavix to Clot-Busting Regimen Saves Lives
ESC: Pretreatment with Plavix Reduces MI, Stroke, and Death Before and After Stenting
Plavix-Aspirin Combo Reduces Acute Heart Attack Deaths
Finally, a pair of low-tech but significant observations: dyspnea is not a benign symptom, and for men heart rate reveals volumes.
First, a study of almost 18,000 patients referred for cardiac stress testing found that people with no known coronary artery disease who report a history of dyspnea are four times more likely to die from heart disease than asymptomatic patients.
Second, a study of 5,713 French men found that when a man's heart rate is too fast at rest, he had a 3.5-fold increase in risk of sudden cardiac death. Moreover, if a man had less than an optimum increase in heart rate during exercise, his risk of sudden death was 20% higher than men whose hearts speeded up appropriately during exercise.
Dyspnea Is Predictive of Cardiac and All-Cause Mortality
Sudden Death in Healthy Men Can Be Predicted by Heart Rate
Those advances have made a dent in mortality, which declined from 322 per 100,000 in 1990 to 241 per 100,000 in 2002, but heart disease is unlikely to lose its No. 1 killer title any time soon.
The reason, authorities say, is that prevention is an elusive goal, not yet within the grasp of the cardiology's considerable reach.
For example, according to the CDC's National Center for Health Statistics, about half of America's aging baby boomers have hypertension and almost 40% are obese-a combination that is likely to spell cardiovascular mortality for many.
And yet another study found that nearly one in five Americans from the age of 12 through 49 -- an estimated 16 million -- can't pass a simple physical fitness treadmill test.
Nearing Medicare, Boomers Need Diets and Blood Pressure Control
Americans in Droves Flunk Fitness Test
While the diet-and-fitness message continues to be ignored by many Americans, researchers have been investigating mechanisms of heart disease progression as way to develop secondary prevention strategies.
Inflammation is considered a major contributor to plaque instability, which led many researchers to suggest that infection may be a trigger for cardiovascular events. And if infection could trigger an event, then antibiotics might prevent events.
That was the theory anyway, and 2005 was the year that it was debunked.
In a National Heart, Lung, and Blood Institute (NHLBI) trial, patients with stable coronary artery disease who underwent a year-long course of weekly azithromycin therapy were no less likely to have a heart attack or stroke than patients taking placebo.
Likewise, in a study sponsored by Bristol-Myers Squibb and Sankyo, acute coronary syndrome patients treated with Tequin (gatifloxacin) for a mean of two years had no reduction in cardiac events compared to patients randomized to placebo.
In announcing the negative results, NHLBI Director Elizabeth G. Nabel, M.D., said it was clear the antibiotics did not work, and it is time to focus prevention efforts on "the controllable risk factors for preventing coronary events."
No Role for Antibiotics in Cardiovascular Secondary Prevention
Another popular theory, that aggressive lipid lowering with high-dose Lipitor (atorvastatin) is better than standard therapy with Zocor (simvastatin) or other less potent statins, retained its adherents even though it was not confirmed in one major study.
That study, Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) trial, found that high dose Lipitor did not achieve a statistically significant benefit compared with usual-dose treatment with Zocor (simvastatin) in patients with a history of acute myocardial infarction.
Patients randomized to 80 mg of Lipitor had an 11% relative reduction in major coronary events versus patients randomized to 20 mg of Zocor (P=0.07).
Moreover the aggressive treatment failed to achieve a significant benefit even though high-dose Lipitor lowered LDL to 81 mg/dL versus 104 mg/dL in the Zocor group. There were no significant differences in either cardiovascular or all-cause mortality.
But those results did little to dampen the enthusiasm of many cardiologists who said they will stick to high=dose Lipitor regimens, and they have solid evidence to back up that clinical decision. In the Treating to New Targets (TNT) trial, which enrolled 10,001 patients with stable coronary disease, treatment with high-dose Lipitor to mean LDL levels of 77 mg/dL was associated with a 22% reduction in risk of major cardiovascular events compared with patients treated to a mean LDL of 101 mg/dL.
When he reported the TNT findings at the American College of Cardiology meeting in March, principal investigator John C. LaRosa, M.D., of the State University of New York Health Science Center in Brooklyn said, "We have entered a new era in the treatment of established coronary disease from starting at an LDL of 100."
AHA: High-Dose Lipitor Does Not Outdo Standard-Dose Zocor
ACC: LDL Cholesterol of Less than 80 mg/dL Reduces Risk of Heart Attack and Stroke
But a big-stick statin may not always be the safest treatment choice, according to an analysis of post-marketing safety reports from patients using Crestor (rosuvastatin), a super-potent statin, Lipitor (atorvastatin), Zocor (simvastatin), or Pravachol (pravastatin).
Patients taking Crestor were eight times more likely to develop rhabdomyolysis, nephropathy, renal failure or proteinuria than patients taking Pravachol, and 6.5 times more likely to develop those complications than patients taking Lipitor.
Richard H. Karas, M.D., Ph.D., director of preventive cardiology and the Woman's Heart Center at Tuft-New England Medical Center, noted that the absolute risk remains low: 28 events per million prescriptions for Crestor, versus 13 per million for Zocor, 3.5 per million for Pravachol, and 4.3 per million for Lipitor.
Safety and efficacy of devices was also a big issue this year, and most of the news for Guidant was bad. The device maker was forced to recall 170,000 pacemakers and implantable defibrillators, which was more than half of the company's devices. Moreover, Guidant's problems triggered a months' long series of events that included a demand by cardiologists for a reworking of device safety alerts and recalls and a two-day FDA conference on device safety.
Implantable Devices Take a Licking but Don't Always Keep on Ticking
Cardiologists Urge Changes in Safety Regs and Guidelines for ICD Use
Crestor Called Less Safe Than Other Statins
But while the year was a rocky one for the heart-device industry, it was another boom year for drug-eluting stents. These stents-Cypher, which delivers sirolimus to the endothelium and Taxus, which carries a payload of paclitaxol-now are the stents of choice for most interventionists. What remains, of course, is heavy competition between the two.
In this head-to-head race, Cypher came away as the winner in trials reported this year.
ACC: Cypher Stent Edges Ahead of Taxus in Head-to-Head Trials
ACC: Cypher Bests Taxus in All Comers Comparison Study
Just as Cypher was the odds-on-favorite in the world of stents, Plavix (clopidogrel) was this year's winner for the drug reporting the most positive trial results. It was difficult to find a cardiology journal, or a cardiology conference that didn't feature a positive Plavix study. The take home message was clear: give it early and often.
ACC: Adding Plavix to Clot-Busting Regimen Saves Lives
ESC: Pretreatment with Plavix Reduces MI, Stroke, and Death Before and After Stenting
Plavix-Aspirin Combo Reduces Acute Heart Attack Deaths
Finally, a pair of low-tech but significant observations: dyspnea is not a benign symptom, and for men heart rate reveals volumes.
First, a study of almost 18,000 patients referred for cardiac stress testing found that people with no known coronary artery disease who report a history of dyspnea are four times more likely to die from heart disease than asymptomatic patients.
Second, a study of 5,713 French men found that when a man's heart rate is too fast at rest, he had a 3.5-fold increase in risk of sudden cardiac death. Moreover, if a man had less than an optimum increase in heart rate during exercise, his risk of sudden death was 20% higher than men whose hearts speeded up appropriately during exercise.
Dyspnea Is Predictive of Cardiac and All-Cause Mortality
Sudden Death in Healthy Men Can Be Predicted by Heart Rate
Friday, December 30, 2005
Investindo em Educação e Saúde
Investindo em educaão e saúde
Caros amigos,
Desejo-lhes um Feliz ano novo, com muita esperança, amor e sucesso.
Abiaxo vai artigo meu que Zero Hora publicou no dia de hoje.
A inspiração veio da Dra. Valderês e do livro do Vinod Thomas, ex diretor do Banco Mundial no Brasil, cuja referência está na materia postada imediatamente antes. "O Brasil Visto por Dentro"
Um abraço a todos.
ALOYZIO ACHUTTI: Membro da Academia Sul-Rio-Grandense de Medicina
Superávit primário, dívida externa, dívida social, cotação do dólar, risco Brasil, salário mínimo, bolsa de valores, produto interno bruto, ajuste fiscal, reforma da previdência...
Estes e outros temas são assunto de todo o dia, de manchetes, de discussões acaloradas e objeto de propaganda política, nem sempre bem intencionada.
Tudo isso, e muito mais, diz respeito à gente que vive neste país, corresponde aos nossos 185 milhões de concidadãos. Tem a ver com o que produzimos, consumimos, gastamos, exportamos, desperdiçamos e investimos, dentro desta enorme e rica propriedade natural nem sempre bem conservada e gerida.
Proponho medir parte de nossa riqueza, com unidades não convencionais e monetárias, mas aproximando-nos um pouco mais do valor potencial vivo de nosso capital humano. Pelos padrões atualmente existentes poderíamos estimá-lo em cerca de 13.210.436.478 anos potenciais de vida.
Quantidades, entretanto, não expressam toda a realidade; ou melhor, muitas vezes escondem parte importante e inconveniente dela. Nos adaptamos a manipulações deste tipo, especialmente quando querem nos mostrar que a economia vai bem, apesar de toda a corrupção, desperdício e malversação de recursos. Os números, especialmente quando mostrados setorialmente, são facilmente manipuláveis, e servem também para ocultar graves defeitos de qualidade.
Do conceito de saúde, entretanto, a qualidade de vida é parte indissociável. Não nos conformamos com somente maior número de anos vividos. Trata-se de capitalizar anos de vida saudáveis.
Estudando informações relativas à saúde de nossa população com dados de 1998 foi possível estimar em 37.518.239 o número de anos de vida saudáveis perdidos a cada ano no Brasil, por todas as causas de doença, violências, incapacidade ou morte precoce. Estendendo este cálculo para nosso capital humano global, chega-se a um desperdício – por problemas em grande parte evitáveis - de 20% a 30% dos anos potenciais de vida saudável responsáveis pela produção e conservação de nossas riquezas.
Avaliando a saúde de nossa sociedade, através da equidade na distribuição das riquezas, também se chega a uma proporção semelhante (dependendo do critério utilizado) de pessoas socialmente excluídas que poderiam estar contribuindo para o processo produtivo, aumentando nossa riqueza, aliviando a carga das doenças, participando no controle social e reduzindo conflitos oriundos da desigualdade exagerada.
Marcos de mudança nos ciclos temporais, são ocasiões para reflexão, balanço e bons propósitos. Redefinições políticas são essenciais, mas a incorporação das mudanças na cultura, e na consciência de cada cidadão, implica num processo educacional sério e sustentado.
A fórmula mais eficaz para sanar nossa economia global - deixando ela a desejar quantitativa e qualitativamente - está na participação efetiva na administração de nossos recursos, e na mobilização de nosso capital físico, nosso capital humano e no trabalho produtivo. Assim, somente como ganho em anos potenciais de vida saudáveis de nossa população, podemos esperar rendimentos em torno de 30%.
Pode haver melhor investimento do que em educação e saúde?
Caros amigos,
Desejo-lhes um Feliz ano novo, com muita esperança, amor e sucesso.
Abiaxo vai artigo meu que Zero Hora publicou no dia de hoje.
A inspiração veio da Dra. Valderês e do livro do Vinod Thomas, ex diretor do Banco Mundial no Brasil, cuja referência está na materia postada imediatamente antes. "O Brasil Visto por Dentro"
Um abraço a todos.
ALOYZIO ACHUTTI: Membro da Academia Sul-Rio-Grandense de Medicina
Superávit primário, dívida externa, dívida social, cotação do dólar, risco Brasil, salário mínimo, bolsa de valores, produto interno bruto, ajuste fiscal, reforma da previdência...
Estes e outros temas são assunto de todo o dia, de manchetes, de discussões acaloradas e objeto de propaganda política, nem sempre bem intencionada.
Tudo isso, e muito mais, diz respeito à gente que vive neste país, corresponde aos nossos 185 milhões de concidadãos. Tem a ver com o que produzimos, consumimos, gastamos, exportamos, desperdiçamos e investimos, dentro desta enorme e rica propriedade natural nem sempre bem conservada e gerida.
Proponho medir parte de nossa riqueza, com unidades não convencionais e monetárias, mas aproximando-nos um pouco mais do valor potencial vivo de nosso capital humano. Pelos padrões atualmente existentes poderíamos estimá-lo em cerca de 13.210.436.478 anos potenciais de vida.
Quantidades, entretanto, não expressam toda a realidade; ou melhor, muitas vezes escondem parte importante e inconveniente dela. Nos adaptamos a manipulações deste tipo, especialmente quando querem nos mostrar que a economia vai bem, apesar de toda a corrupção, desperdício e malversação de recursos. Os números, especialmente quando mostrados setorialmente, são facilmente manipuláveis, e servem também para ocultar graves defeitos de qualidade.
Do conceito de saúde, entretanto, a qualidade de vida é parte indissociável. Não nos conformamos com somente maior número de anos vividos. Trata-se de capitalizar anos de vida saudáveis.
Estudando informações relativas à saúde de nossa população com dados de 1998 foi possível estimar em 37.518.239 o número de anos de vida saudáveis perdidos a cada ano no Brasil, por todas as causas de doença, violências, incapacidade ou morte precoce. Estendendo este cálculo para nosso capital humano global, chega-se a um desperdício – por problemas em grande parte evitáveis - de 20% a 30% dos anos potenciais de vida saudável responsáveis pela produção e conservação de nossas riquezas.
Avaliando a saúde de nossa sociedade, através da equidade na distribuição das riquezas, também se chega a uma proporção semelhante (dependendo do critério utilizado) de pessoas socialmente excluídas que poderiam estar contribuindo para o processo produtivo, aumentando nossa riqueza, aliviando a carga das doenças, participando no controle social e reduzindo conflitos oriundos da desigualdade exagerada.
Marcos de mudança nos ciclos temporais, são ocasiões para reflexão, balanço e bons propósitos. Redefinições políticas são essenciais, mas a incorporação das mudanças na cultura, e na consciência de cada cidadão, implica num processo educacional sério e sustentado.
A fórmula mais eficaz para sanar nossa economia global - deixando ela a desejar quantitativa e qualitativamente - está na participação efetiva na administração de nossos recursos, e na mobilização de nosso capital físico, nosso capital humano e no trabalho produtivo. Assim, somente como ganho em anos potenciais de vida saudáveis de nossa população, podemos esperar rendimentos em torno de 30%.
Pode haver melhor investimento do que em educação e saúde?
O Brasil Visto por Dentro
Grupo Banco Mundial: "Foi lançado neste mês o livro O Brasil visto por dentro " O desenvolvimento em uma terra de contrastes, do ex-diretor do Banco Mundial para o Brasil, Vinod Thomas. Os eventos ocorreram no Rio de Janeiro, São Paulo e Brasília, com a participação de autoridades, pesquisadores e outros interessados..
O Brasil tem um dos maiores potenciais do mundo em desenvolvimento para atingir o progresso sustentado, mas esta realização depende de ações incisivas e urgentes. Esta é a perspectiva do livro, que já está à venda nas melhores livrarias."
O Brasil tem um dos maiores potenciais do mundo em desenvolvimento para atingir o progresso sustentado, mas esta realização depende de ações incisivas e urgentes. Esta é a perspectiva do livro, que já está à venda nas melhores livrarias."
Thursday, December 29, 2005
The Pandemic of Lifestyle Diseases
The Pandemic of Lifestyle Diseases
The WHO estimates that atherosclerosis and diabetes (90% of the Type 2 variety) kill about 16 million people every year, more than are killed by war, famine and malaria combined, and more than might concievably be killed in a single pandemic of bird flu. Half of these deaths occur in people under 70 years old and at least 80% are preventable with simple lifestyle changes.
The ancient Greeks were very perceptive. They gave their god of medicine, Asclepius, two daughters, Panaceia, the goddess of the quick fix and Hygeia, the goddess of prevention and treatment of disease by healthy lifestyle. We have developed this site will prove to you that lifestyle change, Hygeia, is the only way to prevent and treat these diseases. The classic description of the principles of Hygeia was given by Hippocrates about 430 BC.
Drugs and procedures, Panaceia, only treat symptoms and will not decrease total mortality. There is increasing evidence that Panaceia will actually kill more people than it could possibly save.
The bas-relief in the header of Hygeia with her sacred snake was done in 1955 by Armand Filion. It can be seen above the Cedar Avenue entrance to Livingstone Hall, the former nurses' residence at the Montreal General Hospital in Montr�al, Qu�bec, Canada
The WHO estimates that atherosclerosis and diabetes (90% of the Type 2 variety) kill about 16 million people every year, more than are killed by war, famine and malaria combined, and more than might concievably be killed in a single pandemic of bird flu. Half of these deaths occur in people under 70 years old and at least 80% are preventable with simple lifestyle changes.
The ancient Greeks were very perceptive. They gave their god of medicine, Asclepius, two daughters, Panaceia, the goddess of the quick fix and Hygeia, the goddess of prevention and treatment of disease by healthy lifestyle. We have developed this site will prove to you that lifestyle change, Hygeia, is the only way to prevent and treat these diseases. The classic description of the principles of Hygeia was given by Hippocrates about 430 BC.
Drugs and procedures, Panaceia, only treat symptoms and will not decrease total mortality. There is increasing evidence that Panaceia will actually kill more people than it could possibly save.
The bas-relief in the header of Hygeia with her sacred snake was done in 1955 by Armand Filion. It can be seen above the Cedar Avenue entrance to Livingstone Hall, the former nurses' residence at the Montreal General Hospital in Montr�al, Qu�bec, Canada
NHLBI, DASH Eating Plan
NHLBI, DASH Eating Plan: "I give a copy of this to all my hypertensive patients, and have received good feedback. They have found it informative and easy to understand.' -M. Keen, MD Toledo, OH
Get with the plan that is clinically proven to significantly reduce blood pressure. It's not enough to tell hypertensive and prehypertensive patients to, 'Watch your diet.' Give them a week's worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the 'Dietary Approaches to Stop Hypertension' clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping. Facts About the DASH Eating Plan 24 pages. NIH Publication No. 03-4082."
Get with the plan that is clinically proven to significantly reduce blood pressure. It's not enough to tell hypertensive and prehypertensive patients to, 'Watch your diet.' Give them a week's worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the 'Dietary Approaches to Stop Hypertension' clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping. Facts About the DASH Eating Plan 24 pages. NIH Publication No. 03-4082."
Fundação do Incor deve R$ 200 milhões
De: Isaac roitman [mailto:iroitman@imagelink.com.br]
Enviada em: quarta-feira, 28 de dezembro de 2005 23:46
Assunto: Fw: incor
Publicado na Folha de SP
Demorou p/ aparecer as evidências.
Fundação do Incor deve R$ 200 milhões
FABIANE LEITE
da Folha de S.Paulo
A dívida da Fundação Zerbini, entidade privada que administra o maior instituto público de cardiologia da América Latina, o Incor de São Paulo, chega hoje a R$ 200 milhões, diante de um orçamento de R$ 230 milhões anuais.
O quadro foi apresentado ontem pelo conselho deliberativo do Hospital das Clínicas da USP, ao qual o Incor está ligado, e pela própria fundação. As duas instituições estão em guerra por causa do endividamento, mas ambas cobraram ações do governo Geraldo Alckmin (PSDB) para a solução do problema.
O hospital quer um auxílio financeiro para o pagamento. Já a fundação cobra verbas que não teriam sido repassadas pelo governador. O instituto faz hoje um total de 250 mil consultas por ano, em média, 13 mil internações, 5.000 cirurgias e 2 milhões de exames diagnósticos. Problemas no atendimento não estão descartados, a longo prazo, caso a situação não se resolva.
A Zerbini foi criada com anuência do HC para melhorar a estrutura do Incor, como acelerar as contratações e viabilizar mais rapidamente os investimentos, justamente por não ter as amarras de um órgão estatal.
O conselho do hospital atribui o endividamento a uma má gestão de verbas pelo hoje presidente do Incor e do conselho curador da fundação, José Ramires, e tentou afastá-lo do cargo.
"A fundação está tecnicamente falida, pois não tem patrimônio para pagar a dívida", afirma Marcos Boulos, integrante do conselho deliberativo do hospital.
Ontem, o HC apresentou resultados de uma auditoria independente que aponta controles inadequados das compras e estoques da fundação.
Segundo o órgão, a situação "é grave".
Já Paulo Bonadies, advogado de José Ramires, acusou ontem o governo Alckmin de "tungar", nos últimos cinco anos, R$ 100 milhões destinados à entidade que defende, isso principalmente em razão de repasses não realizados pelo governador e aportes feitos pelo governo federal, mas não direcionados pelo Estado à Zerbini, de acordo com sua versão.
Ainda segundo Bonadies, Alckmin não teria honrado compromisso do ex-governador Mário Covas de pagar empréstimo de R$ 40 milhões do BNDES (Banco Nacional de Desenvolvimento Econômico e Social), dívida de longo prazo assumida pela fundação e que chega a R$ 120 milhões.
"A fundação arca com dois terços do custeio do Incor, hoje de R$ 230 milhões", afirmou o advogado da Zerbini. "Há um clima de beligerância, disputa de egos. Eles [o conselho] estão matando a galinha dos ovos de ouro do hospital, do Incor [a fundação], e diminuindo a oportunidade de se tratar em um centro de excelência",
continuou, classificando em seguida o conselho do hospital como "uma turba", que estaria causando, com as acusações, dificuldades para a fundação obter novos empréstimos no sistema financeiro e recursos de doações. Bonadies nega a falência.
Segundo o advogado, a fundação vem pagando 1.600 funcionários que deveriam estar sob responsabilidade do governo do Estado. O hospital informou que recentemente Alckmin assumiu os salários de mais de 900 funcionários, o que melhorará a situação financeira da Fundação Zerbini.
Alckmin trata a polêmica como um desentendimento entre as duas instituições e informou que vem destinando adequadamente recursos ao Incor.
A Fundação Zerbini também está em pé de guerra com o Ministério Público do Estado de São Paulo, que acompanha o desempenho da instituição.
Ontem o advogado da entidade chamou o promotor que cuida do setor, Paulo José de Palma, de "pústula", em razão de Palma, supostamente, não ter apresentado provas de que a entidade está sob investigação do órgão público.
"Vou levar o caso à Corregedoria [do Ministério Público]", ameaçou. O promotor afirma não ter dado acesso às investigações porque o advogado não teria procuração da Zerbini para trabalhar em nome da instituição. Ele não quis comentar o xingamento do advogado e destacou que seu trabalho é técnico. Segundo Palma, há seis investigações sigilosas na Promotoria sobre a fundação.
Outro lado
Nota emitida ontem pela Secretaria de Estado da Saúde diz que as afirmações do cardiologista José Ramires, hoje presidente do Incor de São Paulo, "são inverídicas".
"De maneira nenhuma há dívida entre a Fundação Zerbini e a Secretaria de Estado da Saúde", diz o texto, ao comentar a informação dos advogados do médico de que o governo não teria feito os repasses para a fundação.
"Como afirmou o conselho deliberativo do Hospital das Clínicas, ao qual o Incor é subordinado, a secretaria repassou R$ 600 milhões ao Incor em dez anos, ou seja, R$ 60 milhões por ano", destaca o texto da pasta.
A secretaria também negou que tenha existido um compromisso do ex-governador Mário Covas de pagar um empréstimo assumido pela Fundação Zerbini com o BNDES.
No texto, o governo destaca ainda que o atendimento não será afetado. "Vale ressaltar que a secretaria acredita que as divergências entre HC e Incor serão resolvidas o mais breve possível. A pasta acompanha o caso [...] e confia nas informações do HC de que não há a menor possibilidade do atendimento à população ser prejudicado", diz a nota.
Em entrevista ontem, o HC informou que o governo autorizou a criação de mais de 900 cargos públicos no Incor, em substituição às vagas privadas, que entravam nos gastos da Zerbini. Assim, diz acreditar o conselho deliberativo, a fundação terá folga para saldar a dívida com o BNDES.
O advogado da fundação, Paulo Bonadies, diz que hoje um total de 3.000 funcionários do Incor têm salários pagos pela fundação.
Enviada em: quarta-feira, 28 de dezembro de 2005 23:46
Assunto: Fw: incor
Publicado na Folha de SP
Demorou p/ aparecer as evidências.
Fundação do Incor deve R$ 200 milhões
FABIANE LEITE
da Folha de S.Paulo
A dívida da Fundação Zerbini, entidade privada que administra o maior instituto público de cardiologia da América Latina, o Incor de São Paulo, chega hoje a R$ 200 milhões, diante de um orçamento de R$ 230 milhões anuais.
O quadro foi apresentado ontem pelo conselho deliberativo do Hospital das Clínicas da USP, ao qual o Incor está ligado, e pela própria fundação. As duas instituições estão em guerra por causa do endividamento, mas ambas cobraram ações do governo Geraldo Alckmin (PSDB) para a solução do problema.
O hospital quer um auxílio financeiro para o pagamento. Já a fundação cobra verbas que não teriam sido repassadas pelo governador. O instituto faz hoje um total de 250 mil consultas por ano, em média, 13 mil internações, 5.000 cirurgias e 2 milhões de exames diagnósticos. Problemas no atendimento não estão descartados, a longo prazo, caso a situação não se resolva.
A Zerbini foi criada com anuência do HC para melhorar a estrutura do Incor, como acelerar as contratações e viabilizar mais rapidamente os investimentos, justamente por não ter as amarras de um órgão estatal.
O conselho do hospital atribui o endividamento a uma má gestão de verbas pelo hoje presidente do Incor e do conselho curador da fundação, José Ramires, e tentou afastá-lo do cargo.
"A fundação está tecnicamente falida, pois não tem patrimônio para pagar a dívida", afirma Marcos Boulos, integrante do conselho deliberativo do hospital.
Ontem, o HC apresentou resultados de uma auditoria independente que aponta controles inadequados das compras e estoques da fundação.
Segundo o órgão, a situação "é grave".
Já Paulo Bonadies, advogado de José Ramires, acusou ontem o governo Alckmin de "tungar", nos últimos cinco anos, R$ 100 milhões destinados à entidade que defende, isso principalmente em razão de repasses não realizados pelo governador e aportes feitos pelo governo federal, mas não direcionados pelo Estado à Zerbini, de acordo com sua versão.
Ainda segundo Bonadies, Alckmin não teria honrado compromisso do ex-governador Mário Covas de pagar empréstimo de R$ 40 milhões do BNDES (Banco Nacional de Desenvolvimento Econômico e Social), dívida de longo prazo assumida pela fundação e que chega a R$ 120 milhões.
"A fundação arca com dois terços do custeio do Incor, hoje de R$ 230 milhões", afirmou o advogado da Zerbini. "Há um clima de beligerância, disputa de egos. Eles [o conselho] estão matando a galinha dos ovos de ouro do hospital, do Incor [a fundação], e diminuindo a oportunidade de se tratar em um centro de excelência",
continuou, classificando em seguida o conselho do hospital como "uma turba", que estaria causando, com as acusações, dificuldades para a fundação obter novos empréstimos no sistema financeiro e recursos de doações. Bonadies nega a falência.
Segundo o advogado, a fundação vem pagando 1.600 funcionários que deveriam estar sob responsabilidade do governo do Estado. O hospital informou que recentemente Alckmin assumiu os salários de mais de 900 funcionários, o que melhorará a situação financeira da Fundação Zerbini.
Alckmin trata a polêmica como um desentendimento entre as duas instituições e informou que vem destinando adequadamente recursos ao Incor.
A Fundação Zerbini também está em pé de guerra com o Ministério Público do Estado de São Paulo, que acompanha o desempenho da instituição.
Ontem o advogado da entidade chamou o promotor que cuida do setor, Paulo José de Palma, de "pústula", em razão de Palma, supostamente, não ter apresentado provas de que a entidade está sob investigação do órgão público.
"Vou levar o caso à Corregedoria [do Ministério Público]", ameaçou. O promotor afirma não ter dado acesso às investigações porque o advogado não teria procuração da Zerbini para trabalhar em nome da instituição. Ele não quis comentar o xingamento do advogado e destacou que seu trabalho é técnico. Segundo Palma, há seis investigações sigilosas na Promotoria sobre a fundação.
Outro lado
Nota emitida ontem pela Secretaria de Estado da Saúde diz que as afirmações do cardiologista José Ramires, hoje presidente do Incor de São Paulo, "são inverídicas".
"De maneira nenhuma há dívida entre a Fundação Zerbini e a Secretaria de Estado da Saúde", diz o texto, ao comentar a informação dos advogados do médico de que o governo não teria feito os repasses para a fundação.
"Como afirmou o conselho deliberativo do Hospital das Clínicas, ao qual o Incor é subordinado, a secretaria repassou R$ 600 milhões ao Incor em dez anos, ou seja, R$ 60 milhões por ano", destaca o texto da pasta.
A secretaria também negou que tenha existido um compromisso do ex-governador Mário Covas de pagar um empréstimo assumido pela Fundação Zerbini com o BNDES.
No texto, o governo destaca ainda que o atendimento não será afetado. "Vale ressaltar que a secretaria acredita que as divergências entre HC e Incor serão resolvidas o mais breve possível. A pasta acompanha o caso [...] e confia nas informações do HC de que não há a menor possibilidade do atendimento à população ser prejudicado", diz a nota.
Em entrevista ontem, o HC informou que o governo autorizou a criação de mais de 900 cargos públicos no Incor, em substituição às vagas privadas, que entravam nos gastos da Zerbini. Assim, diz acreditar o conselho deliberativo, a fundação terá folga para saldar a dívida com o BNDES.
O advogado da fundação, Paulo Bonadies, diz que hoje um total de 3.000 funcionários do Incor têm salários pagos pela fundação.
Saturday, December 24, 2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke: "AHA News
12/21/2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association 2005 year-end report:
DALLAS, Dec. 21 - Cell recycling - using a person's own bone marrow - to repair the heart; a gene that may make it possible to predict which patients may benefit from a particular therapy, and a drug that may help smokers reduce their cravings for nicotine, are among the American Heart Association's top 10 research advances in heart disease and stroke for 2005, said Robert Eckel, M.D., president of the American Heart Association.
Other major milestones include hot and cold therapy for stroke rehabilitation, and a study that extended the range of patients that might benefit from prophylactic implantable defibrillators.
The American Heart Association's Top 10 list was created in 1996. Each year's list highlights major gains in heart disease and stroke research.
This year's achievements include:
1. Cell recycling regenerates ailing hearts. Heart attack survivors infused with stem-like cells from their own bone marrow had nearly twice the improvement in their heart's pumping ability as patients given a placebo. Reporting on the 'Intracoronary Infusion of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction: A Randomized, Double-Blind, Placebo Controlled Multicenter Trial (REPAIR),' German researchers said the study is a landmark trial that demonstrates the potential of progenitor therapy for restoring heart function. A second study by another group of German researchers showed that implanting bone marrow cells into blood-starved legs can help people with peripheral "/.../
12/21/2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association 2005 year-end report:
DALLAS, Dec. 21 - Cell recycling - using a person's own bone marrow - to repair the heart; a gene that may make it possible to predict which patients may benefit from a particular therapy, and a drug that may help smokers reduce their cravings for nicotine, are among the American Heart Association's top 10 research advances in heart disease and stroke for 2005, said Robert Eckel, M.D., president of the American Heart Association.
Other major milestones include hot and cold therapy for stroke rehabilitation, and a study that extended the range of patients that might benefit from prophylactic implantable defibrillators.
The American Heart Association's Top 10 list was created in 1996. Each year's list highlights major gains in heart disease and stroke research.
This year's achievements include:
1. Cell recycling regenerates ailing hearts. Heart attack survivors infused with stem-like cells from their own bone marrow had nearly twice the improvement in their heart's pumping ability as patients given a placebo. Reporting on the 'Intracoronary Infusion of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction: A Randomized, Double-Blind, Placebo Controlled Multicenter Trial (REPAIR),' German researchers said the study is a landmark trial that demonstrates the potential of progenitor therapy for restoring heart function. A second study by another group of German researchers showed that implanting bone marrow cells into blood-starved legs can help people with peripheral "/.../
Friday, December 23, 2005
Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ
Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ: "The panels that the Mexican muralist Diego Rivera created for the Mexican National Institute of Cardiology in the 1940s evince a populist concern and celebrate medical technology
The murals Diego Rivera executed for the National Institute of Cardiology in Mexico City (figures 1 and 2) are a testament to his talents as a painter as well as to his prodigious energy. The History of Cardiology consists of two panels of 6 m by 4 m and were completed in time for the inauguration of the new institute building on 18 April 1944. "
The murals Diego Rivera executed for the National Institute of Cardiology in Mexico City (figures 1 and 2) are a testament to his talents as a painter as well as to his prodigious energy. The History of Cardiology consists of two panels of 6 m by 4 m and were completed in time for the inauguration of the new institute building on 18 April 1944. "
Wednesday, December 21, 2005
Erectile Dysfunction a Sign of Looming Heart Risks -
Erectile Dysfunction a Sign of Looming Heart Risks - CME Teaching Brief - MedPage Today: "When patients present with erectile dysfunction, even if no cardiac symptoms are currently present, be aware of the increased risk of future cardiovascular disease, assess risk factors, and intervene as appropriate. "
Tuesday, December 20, 2005
Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of
Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of Care and Outcomes Research Interdisciplinary Writing Group. Cosponsored by the Council on Epidemiology and Prevention and the Stroke Council Endorsed by the American College of Cardiology Foundation
Abstract--With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.
Abstract--With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.
Monday, December 19, 2005
Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation
Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation:
"Background? Although the mechanisms are unknown, it has been suggested that transient exposure to traffic-derived air pollution may be a trigger for acute myocardial infarction. The study aim was to investigate the effects of diesel exhaust inhalation on vascular and endothelial function in humans.
Methods and Results? In a double-blind, randomized, cross-over study, 30 healthy men were exposed to diluted diesel exhaust (300 ?g/m3 particulate concentration) or air for 1 hour during intermittent exercise. Bilateral forearm blood flow and inflammatory factors were measured before and during unilateral intrabrachial bradykinin (100 to 1000 pmol/min), acetylcholine (5 to 20 ?g/min), sodium nitroprusside (2 to 8 ?g/min), and verapamil (10 to 100 ?g/min) infusions 2 and 6 hours after exposure. There were no differences in resting forearm blood flow or inflammatory markers after exposure to diesel exhaust or air. Although there was a dose-dependent increase in blood flow with each vasodilator (P<0.0001 for all), this response was attenuated with bradykinin (P<0.05), acetylcholine (P<0.05), and sodium nitroprusside (P<0.001) infusions 2 hours after exposure to diesel exhaust, which persisted at 6 hours. Bradykinin caused a dose-dependent increase in plasma tissue plasminogen activator (P<0.0001) that was suppressed 6 hours after exposure to diesel (P<0.001; area under the curve decreased by 34%).
Conclusions? At levels encountered in an urban environment, inhalation of dilute diesel exhaust impairs 2 important and complementary aspects of vascular function in humans: the regulation of vascular tone and endogenous fibrinolysis. Thes"
"Background? Although the mechanisms are unknown, it has been suggested that transient exposure to traffic-derived air pollution may be a trigger for acute myocardial infarction. The study aim was to investigate the effects of diesel exhaust inhalation on vascular and endothelial function in humans.
Methods and Results? In a double-blind, randomized, cross-over study, 30 healthy men were exposed to diluted diesel exhaust (300 ?g/m3 particulate concentration) or air for 1 hour during intermittent exercise. Bilateral forearm blood flow and inflammatory factors were measured before and during unilateral intrabrachial bradykinin (100 to 1000 pmol/min), acetylcholine (5 to 20 ?g/min), sodium nitroprusside (2 to 8 ?g/min), and verapamil (10 to 100 ?g/min) infusions 2 and 6 hours after exposure. There were no differences in resting forearm blood flow or inflammatory markers after exposure to diesel exhaust or air. Although there was a dose-dependent increase in blood flow with each vasodilator (P<0.0001 for all), this response was attenuated with bradykinin (P<0.05), acetylcholine (P<0.05), and sodium nitroprusside (P<0.001) infusions 2 hours after exposure to diesel exhaust, which persisted at 6 hours. Bradykinin caused a dose-dependent increase in plasma tissue plasminogen activator (P<0.0001) that was suppressed 6 hours after exposure to diesel (P<0.001; area under the curve decreased by 34%).
Conclusions? At levels encountered in an urban environment, inhalation of dilute diesel exhaust impairs 2 important and complementary aspects of vascular function in humans: the regulation of vascular tone and endogenous fibrinolysis. Thes"
Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use:
Twenty-Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use: The Minnesota Heart Survey, 1980-1982 to 2000-2002 -- Arnett et al. 112 (25): 3884 -- Circulation: "Background� Although US cholesterol concentrations have dropped, &50% of adults have total cholesterol concentrations 5.18 mmol/L, putting them at 'borderline-high risk' for heart disease. Whether the decline has continued into the 21st century is unknown. We assessed 20-year trends in cholesterol, hypercholesterolemia, lipid-lowering drug use, and cholesterol awareness, treatment, and control from Minnesota Heart Survey (MHS) data.
Methods and Results� Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis�St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and contro"
Methods and Results� Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis�St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and contro"
Friday, December 16, 2005
Standardized Cardiovascular Disease Mortality from 1980 to 1999 - Brazil
Balanced Cardiovascular Disease Mortality from 1980 to 1999 - Brazil
Gl�ucia Maria Moraes Oliveira, Nelson Albuquerque Souza e Silva, Carlos Henrique Klein Universidade Federal do Rio de Janeiro, Escola Nacional de Sa�de P�blica e Secretaria de Estado de Sa�de do Rio de Janeiro - Rio de Janeiro, RJ - BrazilOBJECTIVE
To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), S�o Paulo (SP) and Rio Grande do Sul (RS) and respective capitals, from 1980 to 1999.
METHODS
Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro?s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions.
RESULTS
Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively.
CONCLUSION
A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.
Gl�ucia Maria Moraes Oliveira, Nelson Albuquerque Souza e Silva, Carlos Henrique Klein Universidade Federal do Rio de Janeiro, Escola Nacional de Sa�de P�blica e Secretaria de Estado de Sa�de do Rio de Janeiro - Rio de Janeiro, RJ - BrazilOBJECTIVE
To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), S�o Paulo (SP) and Rio Grande do Sul (RS) and respective capitals, from 1980 to 1999.
METHODS
Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro?s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions.
RESULTS
Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively.
CONCLUSION
A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.
Indicadores de Saúde no Brasil
Indicadores de Saúde no Brasil
Aloyzio Cechella Achutti
Health Indicators in Brazil
In the circulatory diseases chapter of this issue of Arquivos Brasileiros de Cardiologia, Dr. Gláucia M.M.Oliveira analyzes mortality data in the states of Rio de Janeiro, São Paulo, Rio Grande do Sul and their respective capitals, during the period of 1980-19991./.../
Nesta edição dos Arquivos Brasileiros de Cardiologia, a Dra. Gláucia M. M. Oliveira publica uma análise sobre dados de mortalidade, no capítulo das doenças do aparelho circulatório, para os estados do Rio de Janeiro, São Paulo, Rio Grande do Sul e suas capitais, no período de 1980-19991./.../
Aloyzio Cechella Achutti
Health Indicators in Brazil
In the circulatory diseases chapter of this issue of Arquivos Brasileiros de Cardiologia, Dr. Gláucia M.M.Oliveira analyzes mortality data in the states of Rio de Janeiro, São Paulo, Rio Grande do Sul and their respective capitals, during the period of 1980-19991./.../
Nesta edição dos Arquivos Brasileiros de Cardiologia, a Dra. Gláucia M. M. Oliveira publica uma análise sobre dados de mortalidade, no capítulo das doenças do aparelho circulatório, para os estados do Rio de Janeiro, São Paulo, Rio Grande do Sul e suas capitais, no período de 1980-19991./.../
Monday, December 12, 2005
Determinantes Sociais e Econômicos de Saúde e Doença
Caros amigos,
Enviei para toda a lista AMICOR uma mensagem com copia anexa de um documento preliminar sobre uma proposta para formar um grupo virtual de estudos e de trabalho sobre Determinantes Sociais e Econômicos de Saúde e Doença.
Sugestões, críticas e adesões serão sempre benvindas.
A proposta será discutida com quem tiver condições de comparecer na reunião ordinária do Servilo de Cardiologia do Hospital Moinhos de Vento, no próximo dia 15, 5a. feira, das 7:30 às 8:30 da manhã.
Quem não o tiver recebido pode solicitar para meu endereço.
Um abraço a todos
AA
Enviei para toda a lista AMICOR uma mensagem com copia anexa de um documento preliminar sobre uma proposta para formar um grupo virtual de estudos e de trabalho sobre Determinantes Sociais e Econômicos de Saúde e Doença.
Sugestões, críticas e adesões serão sempre benvindas.
A proposta será discutida com quem tiver condições de comparecer na reunião ordinária do Servilo de Cardiologia do Hospital Moinhos de Vento, no próximo dia 15, 5a. feira, das 7:30 às 8:30 da manhã.
Quem não o tiver recebido pode solicitar para meu endereço.
Um abraço a todos
AA
Friday, December 09, 2005
Lown Fellowship in Cardiovascular Disease in the Developing World
ProCOR: "Lown Fellowship in Cardiovascular Disease in the Developing World
The Lown Fellowship in Cardiovascular Disease in the Developing World offers:
- Emphasis on clinical and community research
- One-year training period
- No ECFMG certificate requirement
The Fellowship was developed in 2002 by the Lown Cardiovascular Center (www.lowncenter.org), which promotes a non-invasive, patient-focused model of cardiovascular care that is particularly applicable in low-resource settings as well as in countries like the US. This model of care has been practiced at the Lown Cardiovascular Center for more than 40 years with demonstrated efficacy ('Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease' Am J Cardiol 2004;93:294-299.)
We invite inquiries and applications from promising candidates who meet the specified criteria outlined below.
Shmuel Ravid, MD, MPH
Director
Lown Fellowship in Cardiovascular Disease in the Developing World
Lown Cardiovascular Research Foundation"
The Lown Fellowship in Cardiovascular Disease in the Developing World offers:
- Emphasis on clinical and community research
- One-year training period
- No ECFMG certificate requirement
The Fellowship was developed in 2002 by the Lown Cardiovascular Center (www.lowncenter.org), which promotes a non-invasive, patient-focused model of cardiovascular care that is particularly applicable in low-resource settings as well as in countries like the US. This model of care has been practiced at the Lown Cardiovascular Center for more than 40 years with demonstrated efficacy ('Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease' Am J Cardiol 2004;93:294-299.)
We invite inquiries and applications from promising candidates who meet the specified criteria outlined below.
Shmuel Ravid, MD, MPH
Director
Lown Fellowship in Cardiovascular Disease in the Developing World
Lown Cardiovascular Research Foundation"
The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ
The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ: "The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031, but the number of people aged under 65 will change little during this period (table). The increase in the number of older people will likely lead to an increase in the number of people who have chronic diseases, including cardiovascular disease. This will impose further workload and financial pressures on the NHS. We examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation."
Peripheral Arterial Disease Guidelines Push Early Diagnosis -
Peripheral Arterial Disease Guidelines Push Early Diagnosis - CME Teaching Brief - MedPage Today: "Be aware that the new peripheral arterial disease guidelines recommend the use of targeted questions to identify patients.
Explain to patients that the guidelines, issued by the major cardiovascular professional societies, emphasize the relationship between coronary artery disease and peripheral arterial disease. "/.../
Explain to patients that the guidelines, issued by the major cardiovascular professional societies, emphasize the relationship between coronary artery disease and peripheral arterial disease. "/.../
Thursday, December 08, 2005
Avoiding heart attacks and strokes: Don't be a victim, protect yourself
WHO | Avoiding heart attacks and strokes:
Don't be a victim, protect yourself:
"Cardiovascular diseases are killing more and more people around the world, striking rich and poor alike. Those who survive a heart attack or stroke often need to take long-term medical treatment. If you have ever had a heart attack or stroke, or had to care for someone who has, you will know that these diseases can seriously affect the life of both the patient and his or her family. The effects can even reach beyond the family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you should read this booklet. It explains why heart attacks and strokes happen and how you can avoid them. It tells you what you should do to avoid becoming a victim. This publication is available for free download, hard copies can be ordered from WHO Press.
Short summary [pdf 34kb]
Part 1. What you should know [pdf 1.52Mb]
Part 2. What you can do [pdf 776kb]
Full report [pdf 2.16Mb]
Don't be a victim, protect yourself:
"Cardiovascular diseases are killing more and more people around the world, striking rich and poor alike. Those who survive a heart attack or stroke often need to take long-term medical treatment. If you have ever had a heart attack or stroke, or had to care for someone who has, you will know that these diseases can seriously affect the life of both the patient and his or her family. The effects can even reach beyond the family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you should read this booklet. It explains why heart attacks and strokes happen and how you can avoid them. It tells you what you should do to avoid becoming a victim. This publication is available for free download, hard copies can be ordered from WHO Press.
Short summary [pdf 34kb]
Part 1. What you should know [pdf 1.52Mb]
Part 2. What you can do [pdf 776kb]
Full report [pdf 2.16Mb]
guidelines to raise HDL levels
Today in Cardiology: "Cardiologists and other experts at Johns Hopkins University have issued interim guidelines for physicians on how best to treat low levels of HDL cholesterol and help keep arteries clear from LDL buildup.
In an article published online in the New England Journal of Medicine, the researchers reported that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol."
In an article published online in the New England Journal of Medicine, the researchers reported that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol."
Saturday, December 03, 2005
Coffe and hypertension
Caro Prof. Dr AAchutti, sugiro a leitura aos que se dedicam a pesquisa, prevenção e tratamento da hipertensao arterial dos artigos anexos e da Carta Medica - pags 5 e 6- anexos.
Breve esperamos colocar no mercado uma patente resultante de nossas pesquisas - um fitoterapico de cafe - , em parceria com uma industria farmaceutica nacional ( patente mundial obtida).
Saudacoes
Darcy Lima
Darcy Roberto Lima [drlima@cafeesaude.com.br]
Context Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain.
Objective To examine the association between caffeine intake and incident hypertension in women.
Design, Setting, and Participants Prospective cohort study conducted in the Nurses’ Health Studies (NHSs) I and II of 155 594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires.
We also tested the associations with types of caffeinated beverages.
Main Outcome Measure Incident physician-diagnosed hypertension.
Results During follow-up, 19 541 incident cases of physician-diagnosed hypertension
were reported in NHS I and 13 536 in NHS II. In both cohorts, no linear association
between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend=.29; NHS II, P for trend=.53). Using
categorical analysis, an inverse U-shaped association between caffeine consumption
and incident hypertension was found. Compared with participants in the lowest uintile
of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I,8%-18%;in NHSII, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001).
Conclusion No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted.
JAMA. 2005;294:2330-2335 www.jama.com
C-reactive protein and its role in metabolic syndrome
The Lancet 2005; 366:1954-1959
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]
DOI:10.1016/S0140-6736(05)67786-0
C-reactive protein and its role in metabolic syndrome: mendelian randomisation study
Nicholas J Timpson a , Debbie A Lawlor a, Roger M Harbord a, Tom R Gaunt b, Ian NM Day a b, Lyle J Palmer a c, Andrew T Hattersley d, Shah Ebrahim a, Gordon DO Lowe e, Ann Rumley e and George Davey Smith a
Summary
Background
Circulating C-reactive protein (CRP) is associated with the metabolic syndrome and might be causally linked to it. Our aim was to generate estimates of the association between plasma CRP and metabolic syndrome phenotypes that were free from confounding and reverse causation, to assess the causal role of this protein.
Methods
We examined associations between serum CRP concentration and metabolic syndrome phenotypes in the British Women's Heart and Health Study. We then compared these estimates with those derived from a mendelian randomised framework with common CRP gene haplotypes to generate unconfounded and unbiased estimates of any causal associations.
Findings
In a sample of British women, body-mass index (BMI), systolic blood pressure, waist-to-hip ratio, serum concentrations of HDL cholesterol and triglycerides, and insulin resistance were all associated with plasma CRP concentration. CRP haplotypes were associated with plasma CRP concentration (p<0·0001). With instrumental variable analyses, there was no association between plasma CRP concentration and any of the metabolic syndrome phenotypes analysed. There was strong evidence that linear regression and mendelian randomisation based estimation gave conflicting results for the CRP–BMI association (p=0·0002), and some evidence of conflicting results for the association of CRP with the score for insulin resistance (p=0·0139), triglycerides (p=0·0313), and HDL cholesterol (p=0·0688).
Interpretation
Disparity between estimates of the association between plasma CRP and phenotypes comprising the metabolic syndrome derived from conventional analyses and those from a mendelian randomisation approach suggests that there is no causal association between CRP and the metabolic syndrome phenotypes.
Affiliations
a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK
b Human Genetics Division, School of Medicine, University of Southampton, Southampton, UK
c Laboratory for Genetic Epidemiology, Western Australian Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
d Peninsular Medical School, University of Exeter, Exeter, UK
e Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]
DOI:10.1016/S0140-6736(05)67786-0
C-reactive protein and its role in metabolic syndrome: mendelian randomisation study
Nicholas J Timpson a , Debbie A Lawlor a, Roger M Harbord a, Tom R Gaunt b, Ian NM Day a b, Lyle J Palmer a c, Andrew T Hattersley d, Shah Ebrahim a, Gordon DO Lowe e, Ann Rumley e and George Davey Smith a
Summary
Background
Circulating C-reactive protein (CRP) is associated with the metabolic syndrome and might be causally linked to it. Our aim was to generate estimates of the association between plasma CRP and metabolic syndrome phenotypes that were free from confounding and reverse causation, to assess the causal role of this protein.
Methods
We examined associations between serum CRP concentration and metabolic syndrome phenotypes in the British Women's Heart and Health Study. We then compared these estimates with those derived from a mendelian randomised framework with common CRP gene haplotypes to generate unconfounded and unbiased estimates of any causal associations.
Findings
In a sample of British women, body-mass index (BMI), systolic blood pressure, waist-to-hip ratio, serum concentrations of HDL cholesterol and triglycerides, and insulin resistance were all associated with plasma CRP concentration. CRP haplotypes were associated with plasma CRP concentration (p<0·0001). With instrumental variable analyses, there was no association between plasma CRP concentration and any of the metabolic syndrome phenotypes analysed. There was strong evidence that linear regression and mendelian randomisation based estimation gave conflicting results for the CRP–BMI association (p=0·0002), and some evidence of conflicting results for the association of CRP with the score for insulin resistance (p=0·0139), triglycerides (p=0·0313), and HDL cholesterol (p=0·0688).
Interpretation
Disparity between estimates of the association between plasma CRP and phenotypes comprising the metabolic syndrome derived from conventional analyses and those from a mendelian randomisation approach suggests that there is no causal association between CRP and the metabolic syndrome phenotypes.
Affiliations
a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK
b Human Genetics Division, School of Medicine, University of Southampton, Southampton, UK
c Laboratory for Genetic Epidemiology, Western Australian Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
d Peninsular Medical School, University of Exeter, Exeter, UK
e Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Friday, December 02, 2005
Tuesday, November 29, 2005
Risk of High Blood Pressure Among Young Men Increases With the Degree of Immaturity at Birth -- Johansson et al. 112 (22): 3430 -- Circulation
Risk of High Blood Pressure Among Young Men Increases With the Degree of Immaturity at Birth -- Johansson et al. 112 (22): 3430 -- Circulation: "Background� Survivors of preterm birth constitute a new generation of young adults, but little is known about their long-term health. We investigated the association between gestational age (GA) and risk of high blood pressure (HBP) in young Swedish men and whether GA modified the risk of HBP; ie, whether HBP was related to being born small for gestational age (SGA).
Methods and Results� This population-based cohort study included 329 495 Swedish men born in 1973 to 1981 who were conscripted for military service in 1993 to 2001. Multivariate linear- and logistic-regression analyses were performed. Main outcome measures were systolic and diastolic BPs at conscription. Linear-regression analyses showed that systolic BP increased with decreasing GA (regression coefficient �0.31 mm Hg/wk, P<0.001). Systolic and diastolic BPs both increased with decreasing birth weight for GA, but the association with systolic BP was most evident (regression coefficient �0.67 mm Hg per SD score in birth weight for GA, P<0.001). Compared with men born at term (GA, 37 to 41 weeks), the adjusted odd ratios (95% confidence intervals [CIs]) for high systolic BP (140 mm Hg) were as follows: moderately preterm (33 to 36 weeks), 1.25 (1.19 to 1.30); very preterm (29 to 32 weeks), 1.48 (1.30 to 1.68); and extremely preterm (24 to 28 weeks), 1.93 (1.34 to 2.76). Being SGA was associated only with an increased risk of high systolic BP among men born at 33 weeks or later. The risk estimates for high diastolic BP (90 mm Hg) increased with decreasing GA, but the risk reached significance only among men born moderately preterm.
Conclusions� Preterm bir"
Methods and Results� This population-based cohort study included 329 495 Swedish men born in 1973 to 1981 who were conscripted for military service in 1993 to 2001. Multivariate linear- and logistic-regression analyses were performed. Main outcome measures were systolic and diastolic BPs at conscription. Linear-regression analyses showed that systolic BP increased with decreasing GA (regression coefficient �0.31 mm Hg/wk, P<0.001). Systolic and diastolic BPs both increased with decreasing birth weight for GA, but the association with systolic BP was most evident (regression coefficient �0.67 mm Hg per SD score in birth weight for GA, P<0.001). Compared with men born at term (GA, 37 to 41 weeks), the adjusted odd ratios (95% confidence intervals [CIs]) for high systolic BP (140 mm Hg) were as follows: moderately preterm (33 to 36 weeks), 1.25 (1.19 to 1.30); very preterm (29 to 32 weeks), 1.48 (1.30 to 1.68); and extremely preterm (24 to 28 weeks), 1.93 (1.34 to 2.76). Being SGA was associated only with an increased risk of high systolic BP among men born at 33 weeks or later. The risk estimates for high diastolic BP (90 mm Hg) increased with decreasing GA, but the risk reached significance only among men born moderately preterm.
Conclusions� Preterm bir"
Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting
PLoS Medicine: Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting: "A clinical trial is a research study in which human volunteers are treated and observed to an-swer a particular biomedical question. Clinical trials are one of the most valuable sources of evidence to determine which therapies are safe and effective. However, instances of selective re-porting of results to benefit proprietary interests rather than public health have recently come to light. For example, in 2004, GlaxoSmithKline settled a US$2.5 million lawsuit for suppressing trial results showing that its antidepressant paroxetine (Paxil) increased suicidal ideation in children [1]. More re-cently, Merck and Pfizer have been criticized for with-holding results showing increased risk of heart disease from COX-2 drugs such as rofecoxib (Vioxx) [2�4], which was withdrawn from the market because of these risks.
A complete public register of trials and the subsequent release of all results are crucially impor-tant to prevent drug and device makers from skewing the public record on the effectiveness of therapies. However, even when local laws require that trials be registered, compliance has been incomplete. In the United States, the Food and Drug Administration Modernization Act [5] requires that all trials on life-threatening diseases be registered into ClinicalTrials.gov (a register maintained by the National Institutes of Health), yet only 48% of industry-sponsored trials were registered during the initial period of the law's implementation [6]. Moreover, trials are sometimes registered with uninformative data (e.g., not giving the name of the tested drug) [7], thus subverting the central purpose of registration, which is to increase transparency."/.../
A complete public register of trials and the subsequent release of all results are crucially impor-tant to prevent drug and device makers from skewing the public record on the effectiveness of therapies. However, even when local laws require that trials be registered, compliance has been incomplete. In the United States, the Food and Drug Administration Modernization Act [5] requires that all trials on life-threatening diseases be registered into ClinicalTrials.gov (a register maintained by the National Institutes of Health), yet only 48% of industry-sponsored trials were registered during the initial period of the law's implementation [6]. Moreover, trials are sometimes registered with uninformative data (e.g., not giving the name of the tested drug) [7], thus subverting the central purpose of registration, which is to increase transparency."/.../
Cardiopulmonar Resuscitation - Part 1: Introduction
Part 1: Introduction -- , 10.1161/CIRCULATIONAHA.105.166550 -- Circulation
This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American
Heart Association in Dallas, Texas, January 23–30, 2005.These guidelines supersede the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care./.../
Several other chapters follow on the same issue. The addresses to *.pdf are to open access.
Part 2: Ethical Issues
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166551
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166551v1?etoc
Part 3: Overview of CPR
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166552
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166552v1?etoc
Part 4: Adult Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166553
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166553v1?etoc
Part 5: Electrical Therapies. Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166554
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166554v1?etoc
Part 6: CPR Techniques and Devices
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166555
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166555v1?etoc
Part 7.1: Adjuncts for Airway Control and Ventilation
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166556
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166556v1?etoc
Part 7.2: Management of Cardiac Arrest
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166557
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166557v1?etoc
Part 7.3: Management of Symptomatic Bradycardia and Tachycardia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166558
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166558v1?etoc
Part 7.4: Monitoring and Medications
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166559
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166559v1?etoc
Part 7.5: Postresuscitation Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166560
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166560v1?etoc
Part 8: Stabilization of the Patient With Acute Coronary Syndromes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166561
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166561v1?etoc
Part 9: Adult Stroke
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166562
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166562v1?etoc
Part 10.1: Life-Threatening Electrolyte Abnormalities
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166563
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166563v1?etoc
Part 10.2: Toxicology in ECC
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166564
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166564v1?etoc
Part 10.3: Drowning
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166565
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166565v1?etoc
Part 10.4: Hypothermia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166566
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166566v1?etoc
Part 10.5: Near-Fatal Asthma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166567
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166567v1?etoc
Part 10.6: Anaphylaxis
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166568
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166568v1?etoc
Part 10.7: Cardiac Arrest Associated With Trauma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166569
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166569v1?etoc
Part 10.8: Cardiac Arrest Associated With Pregnancy
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166570
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166570v1?etoc
Part 10.9: Electric Shock and Lightning Strikes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166571
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166571v1?etoc
Part 11: Pediatric Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166572
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166572v1?etoc
Part 12: Pediatric Advanced Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166573
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166573v1?etoc
Part 13: Neonatal Resuscitation Guidelines
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166574
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166574v1?etoc
Part 14: First Aid
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166575
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166575v1?etoc
Major Changes in the 2005 AHA Guidelines for CPR and ECC. Reaching the Tipping Point for Change
Mary Fran Hazinski, Vinay M. Nadkarni, Robert W. Hickey, Robert Connor, Lance B. Becker, and Arno Zaritsky
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170809
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170809v1?etoc
Management of Conflict of Interest Issues in the Activities of the American Heart Association Emergency Cardiovascular Care Committee, 2000-2005
John E. Billi, Brian Eigel, William H. Montgomery, Vinay M. Nadkarni, and Mary Fran Hazinski
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170810
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170810v1?etoc
This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American
Heart Association in Dallas, Texas, January 23–30, 2005.These guidelines supersede the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care./.../
Several other chapters follow on the same issue. The addresses to *.pdf are to open access.
Part 2: Ethical Issues
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166551
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166551v1?etoc
Part 3: Overview of CPR
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166552
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166552v1?etoc
Part 4: Adult Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166553
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166553v1?etoc
Part 5: Electrical Therapies. Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166554
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166554v1?etoc
Part 6: CPR Techniques and Devices
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166555
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166555v1?etoc
Part 7.1: Adjuncts for Airway Control and Ventilation
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166556
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166556v1?etoc
Part 7.2: Management of Cardiac Arrest
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166557
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166557v1?etoc
Part 7.3: Management of Symptomatic Bradycardia and Tachycardia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166558
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166558v1?etoc
Part 7.4: Monitoring and Medications
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166559
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166559v1?etoc
Part 7.5: Postresuscitation Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166560
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166560v1?etoc
Part 8: Stabilization of the Patient With Acute Coronary Syndromes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166561
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166561v1?etoc
Part 9: Adult Stroke
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166562
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166562v1?etoc
Part 10.1: Life-Threatening Electrolyte Abnormalities
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166563
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166563v1?etoc
Part 10.2: Toxicology in ECC
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166564
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166564v1?etoc
Part 10.3: Drowning
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166565
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166565v1?etoc
Part 10.4: Hypothermia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166566
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166566v1?etoc
Part 10.5: Near-Fatal Asthma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166567
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166567v1?etoc
Part 10.6: Anaphylaxis
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166568
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166568v1?etoc
Part 10.7: Cardiac Arrest Associated With Trauma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166569
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166569v1?etoc
Part 10.8: Cardiac Arrest Associated With Pregnancy
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166570
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166570v1?etoc
Part 10.9: Electric Shock and Lightning Strikes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166571
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166571v1?etoc
Part 11: Pediatric Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166572
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166572v1?etoc
Part 12: Pediatric Advanced Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166573
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166573v1?etoc
Part 13: Neonatal Resuscitation Guidelines
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166574
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166574v1?etoc
Part 14: First Aid
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166575
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166575v1?etoc
Major Changes in the 2005 AHA Guidelines for CPR and ECC. Reaching the Tipping Point for Change
Mary Fran Hazinski, Vinay M. Nadkarni, Robert W. Hickey, Robert Connor, Lance B. Becker, and Arno Zaritsky
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170809
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170809v1?etoc
Management of Conflict of Interest Issues in the Activities of the American Heart Association Emergency Cardiovascular Care Committee, 2000-2005
John E. Billi, Brian Eigel, William H. Montgomery, Vinay M. Nadkarni, and Mary Fran Hazinski
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170810
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170810v1?etoc
Friday, November 25, 2005
Men Born Preterm at Increased Risk for High Blood Pressure -
Men Born Preterm at Increased Risk for High Blood Pressure - CME Teaching Brief - MedPage Today: "Men Born Preterm at Increased Risk for High Blood Pressure
By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: ABC News, Forbes
MedPage Today Action Points
Explain to patients with a history if premature birth that this study showed a direct and proportional association between an increase in systolic blood pressure and decreased gestational age. There was also an association between diastolic blood pressure and premature birth. "
By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: ABC News, Forbes
MedPage Today Action Points
Explain to patients with a history if premature birth that this study showed a direct and proportional association between an increase in systolic blood pressure and decreased gestational age. There was also an association between diastolic blood pressure and premature birth. "
Stress Can Cause Rising Cholesterol Levels -
Stress Can Cause Rising Cholesterol Levels - CME Teaching Brief - MedPage Today: "Stress Can Cause Rising Cholesterol Levels
By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: BBC News
MedPage Today Action Points
Understand that in this study, participants who initially responded with high levels of stress to a psychological challenge test had the highest levels of cholesterol three years later.
Review
LONDON, Nov. 23 - Stress can cause cholesterol levels to climb, researchers here have found.
A study of 199 men and women here found that 'a person's reaction to stress is one mechanism through which higher lipid levels may develop,' said epidemiologist Andrew Steptoe, D.Sc., of University College London.
He and colleague Lena Brydon, Ph.D., reported in the November issue of Health Psychology that people who showed high levels of stress responses on a test designed to evoke them had more unfavorable lipid profiles three years later than did people who took the same test but managed it without stressful responses.
The participants were 199 men and women who were part of the Whitehall II study. Three years earlier it assessed demographic, psychosocial, and biological risk factors for coronary artery disease in more than 10,000 British civil servants.
The investigators measured cardiovascular, inflammatory, and hemostatic responses as participants performed moderately stressful behavioral tasks involving color and word matching on a computer screen, and tracing an image seen in a mirror.
They were evaluated for stress-induced changes in total cholesterol, LDL cholesterol concentration, HDL /.../"
By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: BBC News
MedPage Today Action Points
Understand that in this study, participants who initially responded with high levels of stress to a psychological challenge test had the highest levels of cholesterol three years later.
Review
LONDON, Nov. 23 - Stress can cause cholesterol levels to climb, researchers here have found.
A study of 199 men and women here found that 'a person's reaction to stress is one mechanism through which higher lipid levels may develop,' said epidemiologist Andrew Steptoe, D.Sc., of University College London.
He and colleague Lena Brydon, Ph.D., reported in the November issue of Health Psychology that people who showed high levels of stress responses on a test designed to evoke them had more unfavorable lipid profiles three years later than did people who took the same test but managed it without stressful responses.
The participants were 199 men and women who were part of the Whitehall II study. Three years earlier it assessed demographic, psychosocial, and biological risk factors for coronary artery disease in more than 10,000 British civil servants.
The investigators measured cardiovascular, inflammatory, and hemostatic responses as participants performed moderately stressful behavioral tasks involving color and word matching on a computer screen, and tracing an image seen in a mirror.
They were evaluated for stress-induced changes in total cholesterol, LDL cholesterol concentration, HDL /.../"
Noisy Environment Linked to Heart Attack Risk - CME Teaching Brief - MedPage Today
Noisy Environment Linked to Heart Attack Risk - CME Teaching Brief - MedPage Today
Advise patients who ask that long-term exposure to high noise levels can damage hearing and recommend ear protection.
Note that this study finds a link between chronic exposure to noise and the risk of myocardial infarction, even after other risk factors are taken into account.
BERLIN, Nov. 23 - Too much noise may increase the risk of heart attack, European researchers say.
In a large case-control study, chronic exposure to environmental noise was associated with an increased risk of myocardial infarction in both men and women, according to Stefan Willich, M.D., of the Charité University Medical Center here./.../
Advise patients who ask that long-term exposure to high noise levels can damage hearing and recommend ear protection.
Note that this study finds a link between chronic exposure to noise and the risk of myocardial infarction, even after other risk factors are taken into account.
BERLIN, Nov. 23 - Too much noise may increase the risk of heart attack, European researchers say.
In a large case-control study, chronic exposure to environmental noise was associated with an increased risk of myocardial infarction in both men and women, according to Stefan Willich, M.D., of the Charité University Medical Center here./.../
Monday, November 21, 2005
Edital Residencias: Instituto Cardiologia-FUC-RS
De: Ruschel [mailto:chaveruschel@cpovo.net]
Enviada em: segunda-feira, 21 de novembro de 2005 21:52
1.1) ENFERMAGEM: (2 ANOS) ...................... 06 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.2) FISIOTERAPIA: (2 ANOS) ....................... 04 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.3) NUTRIÇÃO: (2 ANOS) ........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.4) PSICOLOGIA: (2ANOS)........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.5) MEDICINA: Cardiologia (13 vagas), Área de Atuação Cardiologia Pediátrica (2 vagas), Cirurgia Cardiovascular (2 vagas), Radiologia e Diagnóstico Por Imagem (2 vagas), ver Edital específico a ser publicado em 28 de outubro de 2005 no Jornal Zero Hora e no site www.cardiologia.org.br
Enviada em: segunda-feira, 21 de novembro de 2005 21:52
1.1) ENFERMAGEM: (2 ANOS) ...................... 06 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.2) FISIOTERAPIA: (2 ANOS) ....................... 04 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.3) NUTRIÇÃO: (2 ANOS) ........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.4) PSICOLOGIA: (2ANOS)........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.5) MEDICINA: Cardiologia (13 vagas), Área de Atuação Cardiologia Pediátrica (2 vagas), Cirurgia Cardiovascular (2 vagas), Radiologia e Diagnóstico Por Imagem (2 vagas), ver Edital específico a ser publicado em 28 de outubro de 2005 no Jornal Zero Hora e no site www.cardiologia.org.br
Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery -- Zacharias et al. 112 (21): 3247 -- Circulation
Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery -- Zacharias et al. 112 (21): 3247 -- Circulation: "Conclusions Obesity is an important determinant of new-onset AF after cardiac surgery. Future postoperative AF risk models should incorporate BMI or obesity levels. Studies examining the efficacy of AF-minimizing prophylactic interventions in high-BMI patients, particularly in the elderly, may be warranted. "
Sunday, November 20, 2005
Metabolic syndrome -- Khunti and Davies 331 (7526): 1153 -- BMJ
Metabolic syndrome -- Khunti and Davies 331 (7526): 1153 -- BMJ
Independently raises cardiovascular risk and should be picked up in primary care
Metabolic syndrome is characterised by hyper-insulinaemia, low glucose tolerance, dyslipidaemia, hypertension, and obesity. This cluster of factors has been recognised for many years, but the syndrome was not formally labelled until Reaven did so in 1988 and suggested that insulin resistance was its central characteristic.1 Insulin resistance seems to be the main underlying factor leading to the increased risk of mortality from coronary heart disease among people with the syndrome.2 Strategies to combat the forecast epidemic of type 2 diabetes and its vascular complications should focus on preventing and intervening early in metabolic syndrome./.../
It is becoming increasingly clear that a proinflammatory state is a common feature of the syndrome and of atheromatous disease. A recent randomised controlled trial showed that insulin resistance and measurements of C reactive protein were significantly lower at two year follow-up in patients with metabolic syndrome who had been allocated to a Mediterranean diet than in those who continued their normal diets.12 Although large intervention studies have shown that intensive modification of lifestyle delays the onset of diabetes in patients with impaired glucose tolerance,w9 no similar trials have aimed at reducing all the cardiovascular disease risk factors among people with metabolic syndrome.
Independently raises cardiovascular risk and should be picked up in primary care
Metabolic syndrome is characterised by hyper-insulinaemia, low glucose tolerance, dyslipidaemia, hypertension, and obesity. This cluster of factors has been recognised for many years, but the syndrome was not formally labelled until Reaven did so in 1988 and suggested that insulin resistance was its central characteristic.1 Insulin resistance seems to be the main underlying factor leading to the increased risk of mortality from coronary heart disease among people with the syndrome.2 Strategies to combat the forecast epidemic of type 2 diabetes and its vascular complications should focus on preventing and intervening early in metabolic syndrome./.../
It is becoming increasingly clear that a proinflammatory state is a common feature of the syndrome and of atheromatous disease. A recent randomised controlled trial showed that insulin resistance and measurements of C reactive protein were significantly lower at two year follow-up in patients with metabolic syndrome who had been allocated to a Mediterranean diet than in those who continued their normal diets.12 Although large intervention studies have shown that intensive modification of lifestyle delays the onset of diabetes in patients with impaired glucose tolerance,w9 no similar trials have aimed at reducing all the cardiovascular disease risk factors among people with metabolic syndrome.
Saturday, November 19, 2005
Japanese study: small LDL reductions = big CHD
De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: sexta-feira, 18 de novembro de 2005 22:09
Para: undisclosed-recipients:
Assunto: MEGA (AHA News)
MEGA: Japanese study finds small LDL reductions translate into big CHD
protection
Nov 16, 2005. Michael O'Riordan
Dallas, TX - The addition of a low-dose statin to a low-fat diet rich in
fish reduced the risk of coronary heart disease in a Japanese study of
individuals with moderately elevated cholesterol levels. Investigators
report that the combination of diet and pravastatin 10 mg reduced the risk
of CHD by 33%, approximately the same reduction observed in US and European
primary-prevention trials that have used larger statin doses.
The results of the Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese (MEGA) study were presented today at the
American Heart Association Scientific Sessions 2005. Lead investigator Dr
Haruo Nakamura (National Defense Medical College, Saitama, Japan) said the
purpose of the Japanese study was to examine whether the addition of a
low-dose statin to a diet rich in omega-3 fatty acids could reduce the risk
of CHD. In Japan, the incidence of coronary disease is about one third lower
than the US and Europe, where most of the statin trials have been conducted,
but the risk of stroke and cancer is higher.
Dr Daniel Rader (University of Pennsylvania School of Medicine,
Philadelphia), who commented on the study during the late-breaking
clinical-trials session, called the MEGA study a landmark primary-prevention
trial for the Asian population, not unlike the West of Scotland Coronary
Prevention Study (WOSCOPS) and the Air Force/Texas Coronary Atherosclerosis
Prevention Study (AFCAPS/TexCAPS). He said the results support the concept
that a modest shift in population cholesterol distribution can have a major
impact on the incidence of coronary disease and will spur debate about the
role low-dose statin therapy might have in achieving such a shift.
"The MEGA study will undoubtedly have a major impact on the treatment of
hypercholesterolemia in Asia, as it provides reassurance of safety and proof
of benefit of low-dose statin therapy," said Rader. "It should have impact
in the West, as well. These results suggest that the potential for the
broader use of low-dose statin therapy make it important to utilize
available approaches to identify that subset of healthy individuals who are
at high risk and may merit statin therapy despite only modestly elevated LDL
cholesterol."
Relatively low risk patients
The MEGA study was a prospective, randomized, open-label trial comparing
diet and pravastatin 10 mg with diet alone for the reduction of
first-occurrence CHD in 7832 patients. Of those randomized to statin
therapy, approximately 25% were uptitrated to the 20-mg dose of pravastatin.
The diet followed by patients was low in total cholesterol, low in saturated
fat, and included at least three servings of fish per week.
Average baseline LDL cholesterol levels were 156 mg/dL in both study arms
before treatment. Mean HDL-cholesterol levels were relatively high,
measuring 57 mg/dL in both treatment groups. During a mean follow-up of 5.3
years, treatment with pravastatin 10 mg significantly decreased total- and
LDL-cholesterol levels, 11.5% and 18%, respectively.
The MEGA investigators report that treatment with pravastatin reduced the
risk of CHD 33% compared with patients randomized to diet alone. Although
the absolute benefit was small, a little over a 1% absolute reduction in
risk, the number needed to treat to prevent one additional CHD event was
119.
MEGA: Primary and secondary end points
End point
Hazard ratio (95% CI)
Coronary heart disease (a composite end point of fatal/nonfatal MI, angina,
cardiovascular death, need for revascularization)
0.67 (0.49-0.91)
Coronary heart disease and cerebral infarction
0.70 (0.54-0.90)
Stroke
0.83 (0.57-1.21)
Total mortality
0.72 (0.51-1.01)
Speaking with heartwire, Nakamura said that the relatively small reduction
in LDL-cholesterol levels translated into a statistically significant
reduction in CHD risk, a reduction similar to those observed in the major
lipid-lowering studies. Asked why the 10- to 20-mg dose of pravastatin
yielded benefit that was previously achieved with 20- to 40-mg doses of
pravastatin in the US and Europe, he said he suspects that the traditional
Japanese diet and baseline HDL-cholesterol levels were cardioprotective.
"We understand that LDL cholesterol is very important for developing
coronary heart disease, but not only LDL is important. Levels of HDL are
also important, and there are many studies that have showed a protective
benefit of HDL cholesterol against coronary heart disease. In general,
Japanese people usually have high HDL cholesterol, about 10 mg/dL higher
than people in the US, so this might have provided some protective benefit
that allowed us to reduce the dose of statin in this trial."
Enviada em: sexta-feira, 18 de novembro de 2005 22:09
Para: undisclosed-recipients:
Assunto: MEGA (AHA News)
MEGA: Japanese study finds small LDL reductions translate into big CHD
protection
Nov 16, 2005. Michael O'Riordan
Dallas, TX - The addition of a low-dose statin to a low-fat diet rich in
fish reduced the risk of coronary heart disease in a Japanese study of
individuals with moderately elevated cholesterol levels. Investigators
report that the combination of diet and pravastatin 10 mg reduced the risk
of CHD by 33%, approximately the same reduction observed in US and European
primary-prevention trials that have used larger statin doses.
The results of the Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese (MEGA) study were presented today at the
American Heart Association Scientific Sessions 2005. Lead investigator Dr
Haruo Nakamura (National Defense Medical College, Saitama, Japan) said the
purpose of the Japanese study was to examine whether the addition of a
low-dose statin to a diet rich in omega-3 fatty acids could reduce the risk
of CHD. In Japan, the incidence of coronary disease is about one third lower
than the US and Europe, where most of the statin trials have been conducted,
but the risk of stroke and cancer is higher.
Dr Daniel Rader (University of Pennsylvania School of Medicine,
Philadelphia), who commented on the study during the late-breaking
clinical-trials session, called the MEGA study a landmark primary-prevention
trial for the Asian population, not unlike the West of Scotland Coronary
Prevention Study (WOSCOPS) and the Air Force/Texas Coronary Atherosclerosis
Prevention Study (AFCAPS/TexCAPS). He said the results support the concept
that a modest shift in population cholesterol distribution can have a major
impact on the incidence of coronary disease and will spur debate about the
role low-dose statin therapy might have in achieving such a shift.
"The MEGA study will undoubtedly have a major impact on the treatment of
hypercholesterolemia in Asia, as it provides reassurance of safety and proof
of benefit of low-dose statin therapy," said Rader. "It should have impact
in the West, as well. These results suggest that the potential for the
broader use of low-dose statin therapy make it important to utilize
available approaches to identify that subset of healthy individuals who are
at high risk and may merit statin therapy despite only modestly elevated LDL
cholesterol."
Relatively low risk patients
The MEGA study was a prospective, randomized, open-label trial comparing
diet and pravastatin 10 mg with diet alone for the reduction of
first-occurrence CHD in 7832 patients. Of those randomized to statin
therapy, approximately 25% were uptitrated to the 20-mg dose of pravastatin.
The diet followed by patients was low in total cholesterol, low in saturated
fat, and included at least three servings of fish per week.
Average baseline LDL cholesterol levels were 156 mg/dL in both study arms
before treatment. Mean HDL-cholesterol levels were relatively high,
measuring 57 mg/dL in both treatment groups. During a mean follow-up of 5.3
years, treatment with pravastatin 10 mg significantly decreased total- and
LDL-cholesterol levels, 11.5% and 18%, respectively.
The MEGA investigators report that treatment with pravastatin reduced the
risk of CHD 33% compared with patients randomized to diet alone. Although
the absolute benefit was small, a little over a 1% absolute reduction in
risk, the number needed to treat to prevent one additional CHD event was
119.
MEGA: Primary and secondary end points
End point
Hazard ratio (95% CI)
Coronary heart disease (a composite end point of fatal/nonfatal MI, angina,
cardiovascular death, need for revascularization)
0.67 (0.49-0.91)
Coronary heart disease and cerebral infarction
0.70 (0.54-0.90)
Stroke
0.83 (0.57-1.21)
Total mortality
0.72 (0.51-1.01)
Speaking with heartwire, Nakamura said that the relatively small reduction
in LDL-cholesterol levels translated into a statistically significant
reduction in CHD risk, a reduction similar to those observed in the major
lipid-lowering studies. Asked why the 10- to 20-mg dose of pravastatin
yielded benefit that was previously achieved with 20- to 40-mg doses of
pravastatin in the US and Europe, he said he suspects that the traditional
Japanese diet and baseline HDL-cholesterol levels were cardioprotective.
"We understand that LDL cholesterol is very important for developing
coronary heart disease, but not only LDL is important. Levels of HDL are
also important, and there are many studies that have showed a protective
benefit of HDL cholesterol against coronary heart disease. In general,
Japanese people usually have high HDL cholesterol, about 10 mg/dL higher
than people in the US, so this might have provided some protective benefit
that allowed us to reduce the dose of statin in this trial."
Cartilha do Coração para Crianças
Acaba de ser concluída a cartilha brasileira de prevenção das doenças cardiovasculares em crianças e adolescentes. É a primeira vez que se estabelece quais os parâmetros ideais para a população infanto-juvenil controlar os fatores de risco para infartos e derrames. Com divulgação prevista para esta semana, durante um congresso da Sociedade Brasileira de Cardiologia, o documento traz recomendações sobre peso, pressão arterial, colesterol, atividades físicas, alimentação e níveis de açúcar no sangue. Até agora, alguns médicos aplicavam aos jovens as mesmas diretrizes destinadas aos adultos. Outros adotavam normas estrangeiras – que podiam ser tanto americanas quanto dinamarquesas ou canadenses. A falta de consenso comprometia o diagnóstico e o tratamento dos males que predispõem a infartos e derrames. "A partir de agora, os médicos brasileiros contam com uma ferramenta bastante precisa para preservar a saúde cardiovascular futura dos meninos e meninas de hoje", diz o cardiologista Bruno Caramelli, diretor do departamento de aterosclerose da Sociedade Brasileira de Cardiologia e um dos autores da cartilha.
Criado pelas sociedades brasileiras de cardiologia, pediatria, endocrinologia pediátrica e hipertensão, o documento tem por objetivo conter o avanço de distúrbios tipicamente adultos entre meninos e meninas. A vida sedentária, as dietas gordurosas, a obesidade e o stress estão fazendo com que males como a hipertensão, o colesterol alto e o diabetes comecem a manifestar-se ainda na infância. "Se não controlarmos esse quadro, em menos de três décadas não haverá hospital disponível para abrigar tantos infartados", diz a pediatra Isabela Giuliano, pesquisadora do Instituto do Coração, em São Paulo. Estudos baseados na necropsia de crianças vítimas de morte inesperada mostram que, apesar da idade, algumas apresentavam artérias repletas de estrias, sinal da agressão sofrida pelos vasos sanguíneos e indício de problemas cardiovasculares no futuro. Um desses estudos, publicado na revista científica The New England Journal of Medicine, em 1998, revelou que quase 30% dos meninos e meninas de 2 a 15 anos já tinham as artérias coronárias e a aorta comprometidas.
Estabelecer os níveis ideais de glicemia, colesterol, pressão arterial ou peso para crianças e adolescentes não é tarefa simples. Um bom exemplo é o colesterol. O perfil lipídico de um homem de 40 anos, por exemplo, pode ser muito semelhante ao de outro vinte anos mais velho. O mesmo não acontece, porém, entre um garoto de 1 ano e outro de 5. Até os 2 anos, o colesterol tende a ser abundante na circulação, já que é matéria-prima para a produção de GH, o hormônio do crescimento, e para a maturação dos neurônios (veja quadro). Embora seja mais fácil mudar hábitos de vida de crianças e adolescentes, pelo fato de que ainda não estão tão arraigados, isso exige estratégias de convencimento e educação que devem envolver pais, educadores e médicos. "Não basta dizer a uma criança que o consumo exagerado de gordura pode fazer mal às suas artérias", diz a pediatra. "Mesmo que ela se convença, é provável que se sinta constrangida ao chegar à escola com um sanduíche natural."
Há cerca de dois anos, quando Djeneffer Cris Antero, hoje com 13 anos, recebeu o diagnóstico de colesterol alto, sua mãe até tentou mostrar-lhe o perigo que isso representava. Em vão. A garota continuou preferindo doces e frituras a frutas e verduras. Também não se incomodou em se engajar numa atividade física. Recentemente, Djeneffer descobriu que também sofre de diabetes tipo 2. "Agora eu me assustei de verdade. É muito chato não poder comer o que quero, quando quero, mas vou fazer de tudo para me cuidar." Vale a pena, em nome de um coração saudável por muitos anos.
Criado pelas sociedades brasileiras de cardiologia, pediatria, endocrinologia pediátrica e hipertensão, o documento tem por objetivo conter o avanço de distúrbios tipicamente adultos entre meninos e meninas. A vida sedentária, as dietas gordurosas, a obesidade e o stress estão fazendo com que males como a hipertensão, o colesterol alto e o diabetes comecem a manifestar-se ainda na infância. "Se não controlarmos esse quadro, em menos de três décadas não haverá hospital disponível para abrigar tantos infartados", diz a pediatra Isabela Giuliano, pesquisadora do Instituto do Coração, em São Paulo. Estudos baseados na necropsia de crianças vítimas de morte inesperada mostram que, apesar da idade, algumas apresentavam artérias repletas de estrias, sinal da agressão sofrida pelos vasos sanguíneos e indício de problemas cardiovasculares no futuro. Um desses estudos, publicado na revista científica The New England Journal of Medicine, em 1998, revelou que quase 30% dos meninos e meninas de 2 a 15 anos já tinham as artérias coronárias e a aorta comprometidas.
Estabelecer os níveis ideais de glicemia, colesterol, pressão arterial ou peso para crianças e adolescentes não é tarefa simples. Um bom exemplo é o colesterol. O perfil lipídico de um homem de 40 anos, por exemplo, pode ser muito semelhante ao de outro vinte anos mais velho. O mesmo não acontece, porém, entre um garoto de 1 ano e outro de 5. Até os 2 anos, o colesterol tende a ser abundante na circulação, já que é matéria-prima para a produção de GH, o hormônio do crescimento, e para a maturação dos neurônios (veja quadro). Embora seja mais fácil mudar hábitos de vida de crianças e adolescentes, pelo fato de que ainda não estão tão arraigados, isso exige estratégias de convencimento e educação que devem envolver pais, educadores e médicos. "Não basta dizer a uma criança que o consumo exagerado de gordura pode fazer mal às suas artérias", diz a pediatra. "Mesmo que ela se convença, é provável que se sinta constrangida ao chegar à escola com um sanduíche natural."
Há cerca de dois anos, quando Djeneffer Cris Antero, hoje com 13 anos, recebeu o diagnóstico de colesterol alto, sua mãe até tentou mostrar-lhe o perigo que isso representava. Em vão. A garota continuou preferindo doces e frituras a frutas e verduras. Também não se incomodou em se engajar numa atividade física. Recentemente, Djeneffer descobriu que também sofre de diabetes tipo 2. "Agora eu me assustei de verdade. É muito chato não poder comer o que quero, quando quero, mas vou fazer de tudo para me cuidar." Vale a pena, em nome de um coração saudável por muitos anos.
Monday, November 14, 2005
Managing Abnormal Blood Lipids: A Collaborative Approach -- Fletcher et al. 112 (20): 3184 -- Circulation
Managing Abnormal Blood Lipids: A Collaborative Approach -- Fletcher et al. 112 (20): 3184 -- Circulation
Abstract—Current data and guidelines recommend treating abnormal blood lipids (ABL) to goal. This is a complex process and requires involvement from various healthcare professionals with a wide range of expertise. The model of a multidisciplinary case management approach for patients with ABL is well documented and described. This collaborative approach encompasses primary and secondary prevention across the lifespan, incorporates nutritional and exercise management as a significant component, defines the importance and indications for pharmacological therapy, and emphasizes the importance of adherence. Use of this collaborative approach for the treatment of ABL ultimately will improve cardiovascular and cerebrovascular morbidity and mortality. (Circulation. 2005;112:3184-3209.)
Abstract—Current data and guidelines recommend treating abnormal blood lipids (ABL) to goal. This is a complex process and requires involvement from various healthcare professionals with a wide range of expertise. The model of a multidisciplinary case management approach for patients with ABL is well documented and described. This collaborative approach encompasses primary and secondary prevention across the lifespan, incorporates nutritional and exercise management as a significant component, defines the importance and indications for pharmacological therapy, and emphasizes the importance of adherence. Use of this collaborative approach for the treatment of ABL ultimately will improve cardiovascular and cerebrovascular morbidity and mortality. (Circulation. 2005;112:3184-3209.)
Friday, November 11, 2005
Cardiovascular Disease Mortality in Men
Cardiosource: "Revised Adult Treatment Panel III Guidelines and Cardiovascular Disease Mortality in Men Attending a Preventive Medical Clinic
Topic: Prevention/Vascular
Date Posted: 11/5/2005
Author(s): Ardern CI, Katzmarzyk PT, Janssen I, Church TS, Blair SN.
Citation: Circulation. 2005;112:1478-1485.
Study Question: What is the relative contribution of cardiovascular fitness (CardFit) and the metabolic syndrome on cardiovascular disease (CVD) mortality within each intervention window, as defined by the revised Adult Treatment Panel (ATP) III guidelines (ATP III-R)?
Methods: Risk factor and CardFit data from 19,125 men (aged 20-79 years) who attended a preventive medical clinic between 1979 and 1995 were used. Mortality follow-up was completed until December 31, 1996. Five classic risk factors were considered: age =45 years, family history, current smoker, hypertension, and low high-density lipoprotein cholesterol (HDL-C). Participants were assigned to one of four ATP III-R groups (high risk as coronary heart disease [CHD] or CHD risk equivalent, moderate risk as 2+ risk factors or 10-year Framingham risk of 10-20%, moderate risk 10-year risk <10%, and low risk 0-1 risk factor). The ATP III-R group was then used to assign one of the groups: LDL-C at goal, therapeutic lifestyle change (TLC) initiation, and drug consideration. Unfit was defined as in the lowest age-adjusted lowest quintile. The risk of CVD mortality was assessed by Cox proportional hazards regression.
Results: Mean age was 45 years; 58% were classified as being at the LDL goal, whereas 18% were eligible for TLC initiation and 24% for drug treatment. There were 179 CVD deaths over an average 10.2 years of follow-up. Compared with those with LDL-"
Topic: Prevention/Vascular
Date Posted: 11/5/2005
Author(s): Ardern CI, Katzmarzyk PT, Janssen I, Church TS, Blair SN.
Citation: Circulation. 2005;112:1478-1485.
Study Question: What is the relative contribution of cardiovascular fitness (CardFit) and the metabolic syndrome on cardiovascular disease (CVD) mortality within each intervention window, as defined by the revised Adult Treatment Panel (ATP) III guidelines (ATP III-R)?
Methods: Risk factor and CardFit data from 19,125 men (aged 20-79 years) who attended a preventive medical clinic between 1979 and 1995 were used. Mortality follow-up was completed until December 31, 1996. Five classic risk factors were considered: age =45 years, family history, current smoker, hypertension, and low high-density lipoprotein cholesterol (HDL-C). Participants were assigned to one of four ATP III-R groups (high risk as coronary heart disease [CHD] or CHD risk equivalent, moderate risk as 2+ risk factors or 10-year Framingham risk of 10-20%, moderate risk 10-year risk <10%, and low risk 0-1 risk factor). The ATP III-R group was then used to assign one of the groups: LDL-C at goal, therapeutic lifestyle change (TLC) initiation, and drug consideration. Unfit was defined as in the lowest age-adjusted lowest quintile. The risk of CVD mortality was assessed by Cox proportional hazards regression.
Results: Mean age was 45 years; 58% were classified as being at the LDL goal, whereas 18% were eligible for TLC initiation and 24% for drug treatment. There were 179 CVD deaths over an average 10.2 years of follow-up. Compared with those with LDL-"
Wednesday, November 02, 2005
Guidelines, Lighthouses, and a Toe in the Water
Artigos na �ntegra - Merck Sharp & Dohme: "Guidelines, Lighthouses, and a Toe in the Water
[Editorial]
Holmes, David R. Jr MD; Hodgson, Patricia BA; Singh, Mandeep MD
From Mayo Clinic (D.R.H., M.S.), Rochester, Minn, and Duke Clinical Research Institute (P.H.), Durham, NC.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Mandeep Singh, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
A guideline tells you how to get someplace, whereas a lighthouse keeps you off the rocks; both can shepherd you on a safe journey toward your goal. The American College of Cardiology (ACC), in concert with the American Heart Association (AHA), has been at the forefront of developing guidelines for percutaneous coronary interventions (PCI).1 In an era in which there are multiple data sets to draw from, guidelines help to sort out optimal from less optimal evidence-based approaches. Application of these guidelines makes intuitive sense as we counsel our individual patients about the risk/benefit ratio of PCI and as we develop treatment strategies for healthcare delivery systems to employ."/.../
Putting theory into practice: First survey to show that following guidelines improves outcomes
Nov 1, 2005 Lisa Nainggolan
Houston, TX - The first survey of its kind—involving more than 400 000 patients—has shown that following evidence-based guidelines for cardiac care can improve patient outcomes [1]. The results are published online before print October 31, 2005 in Circulation.
This is a reminder that guidelines can work and be useful.
"This research shows that carefully crafted guidelines can be used to improve quality of care and outcomes. This has not been shown before," lead author Dr H Vernon Anderson (University of Texas Health Science Center, Houston) commented to heartwire.
Anderson said that previous studies have revealed that adoption of effective clinical practices can be scattered, inconsistent, and haphazard, and there can be a tendency for doctors to feel "guideline fatigue" when new recommendations are issued. "But this is a reminder that guidelines can work and be useful," he stressed.
Physicians heeding guidelines
Anderson and colleagues say that the US National Cardiovascular Data Registry (NCDR) was established several years ago to provide an objective mechanism to assess guidelines-based practice. This is the first look at outcomes from the NCDR, which will be used by the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines Committee to periodically reassess and revise clinical practice guidelines.
Using the NCDR, the researchers analyzed the impact of the 2001 ACC/AHA recommendations for selecting patients most likely to benefit from percutaneous coronary interventions [2]. (Procedures for ST-elevation MI were excluded.) They examined patient records from 363 hospitals during the 39 months after the 2001 guidelines were released: 412 617 patients underwent PCI and could be classified according to the recommendations.
The data show that physicians in the participating hospitals (94% community hospitals and 6% university hospitals) seemed to be heeding the guidelines when selecting patients for PCI.
Of all the procedures performed on patients, 64% were designated (according to the guidelines) as class I (medical evidence for and/or general agreement that the procedure is useful and effective) and 21% were class IIa (weight of evidence is in favor of the usefulness).
Of the PCIs, 7% of the procedures conducted were class IIb (usefulness/efficacy is less well established) and 8% were class III (medical evidence and/or general agreement that the procedure is not useful or effective and in some cases may be harmful).
Clinical success declined from almost 93% of class I procedures to 85% of class III procedures. Adverse events (MI, CABG, and death) were generally lower in the class I procedures and highest in class III procedures (with the exception of CABG in class III, which was thought by the researchers to be due to the high percentage of previous CABG in these patients).
Adherence to guidelines associated with better outcomes
The review found a relationship among procedure indications, clinical success, and adverse events, and discovered that a small number of procedures are being carried out against recommendations.
"We observed that most PCI procedures were done for class I indications and that only a small fraction were done against recommendations," the researchers say. "This finding suggests that PCI practice conforms to the guidelines to a large extent, [and] adherence to the recommended indications for PCI was associated with better outcomes.
"A more careful consideration of procedures with class IIb and III indications might improve clinical outcomes and, by extension, the quality of patient care," they note. However, they add that understanding the reasons PCIs are done against recommendations "may provide valuable clues . . . into new or developing approaches."
"Over time, the evidence and the guidelines will change, as they should, and there will always be special cases, but overall, the quality of patient care will be improved by a conscious effort to adhere to guideline recommendations," Anderson concludes.
Sources
Anderson HV, Shaw RE, Brindis RG, et al. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force Guidelines. Circulation 2005; DOI: 10.1161/CIRCULATIONAHA.105.553727. Available at http://circ.ahajournals.org.
Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001; 37:2215-2239.
[Editorial]
Holmes, David R. Jr MD; Hodgson, Patricia BA; Singh, Mandeep MD
From Mayo Clinic (D.R.H., M.S.), Rochester, Minn, and Duke Clinical Research Institute (P.H.), Durham, NC.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Mandeep Singh, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
A guideline tells you how to get someplace, whereas a lighthouse keeps you off the rocks; both can shepherd you on a safe journey toward your goal. The American College of Cardiology (ACC), in concert with the American Heart Association (AHA), has been at the forefront of developing guidelines for percutaneous coronary interventions (PCI).1 In an era in which there are multiple data sets to draw from, guidelines help to sort out optimal from less optimal evidence-based approaches. Application of these guidelines makes intuitive sense as we counsel our individual patients about the risk/benefit ratio of PCI and as we develop treatment strategies for healthcare delivery systems to employ."/.../
Putting theory into practice: First survey to show that following guidelines improves outcomes
Nov 1, 2005 Lisa Nainggolan
Houston, TX - The first survey of its kind—involving more than 400 000 patients—has shown that following evidence-based guidelines for cardiac care can improve patient outcomes [1]. The results are published online before print October 31, 2005 in Circulation.
This is a reminder that guidelines can work and be useful.
"This research shows that carefully crafted guidelines can be used to improve quality of care and outcomes. This has not been shown before," lead author Dr H Vernon Anderson (University of Texas Health Science Center, Houston) commented to heartwire.
Anderson said that previous studies have revealed that adoption of effective clinical practices can be scattered, inconsistent, and haphazard, and there can be a tendency for doctors to feel "guideline fatigue" when new recommendations are issued. "But this is a reminder that guidelines can work and be useful," he stressed.
Physicians heeding guidelines
Anderson and colleagues say that the US National Cardiovascular Data Registry (NCDR) was established several years ago to provide an objective mechanism to assess guidelines-based practice. This is the first look at outcomes from the NCDR, which will be used by the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines Committee to periodically reassess and revise clinical practice guidelines.
Using the NCDR, the researchers analyzed the impact of the 2001 ACC/AHA recommendations for selecting patients most likely to benefit from percutaneous coronary interventions [2]. (Procedures for ST-elevation MI were excluded.) They examined patient records from 363 hospitals during the 39 months after the 2001 guidelines were released: 412 617 patients underwent PCI and could be classified according to the recommendations.
The data show that physicians in the participating hospitals (94% community hospitals and 6% university hospitals) seemed to be heeding the guidelines when selecting patients for PCI.
Of all the procedures performed on patients, 64% were designated (according to the guidelines) as class I (medical evidence for and/or general agreement that the procedure is useful and effective) and 21% were class IIa (weight of evidence is in favor of the usefulness).
Of the PCIs, 7% of the procedures conducted were class IIb (usefulness/efficacy is less well established) and 8% were class III (medical evidence and/or general agreement that the procedure is not useful or effective and in some cases may be harmful).
Clinical success declined from almost 93% of class I procedures to 85% of class III procedures. Adverse events (MI, CABG, and death) were generally lower in the class I procedures and highest in class III procedures (with the exception of CABG in class III, which was thought by the researchers to be due to the high percentage of previous CABG in these patients).
Adherence to guidelines associated with better outcomes
The review found a relationship among procedure indications, clinical success, and adverse events, and discovered that a small number of procedures are being carried out against recommendations.
"We observed that most PCI procedures were done for class I indications and that only a small fraction were done against recommendations," the researchers say. "This finding suggests that PCI practice conforms to the guidelines to a large extent, [and] adherence to the recommended indications for PCI was associated with better outcomes.
"A more careful consideration of procedures with class IIb and III indications might improve clinical outcomes and, by extension, the quality of patient care," they note. However, they add that understanding the reasons PCIs are done against recommendations "may provide valuable clues . . . into new or developing approaches."
"Over time, the evidence and the guidelines will change, as they should, and there will always be special cases, but overall, the quality of patient care will be improved by a conscious effort to adhere to guideline recommendations," Anderson concludes.
Sources
Anderson HV, Shaw RE, Brindis RG, et al. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force Guidelines. Circulation 2005; DOI: 10.1161/CIRCULATIONAHA.105.553727. Available at http://circ.ahajournals.org.
Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001; 37:2215-2239.
Tuesday, November 01, 2005
WHO Study on Prevention of Recurrences of Myocardial Infarction and Stroke
820.pdf (application/pdf Object)
This work on Secondary Prevention of Cronary and Cerebro Vascular Disease, has the contribution of at least three members of th AMICOR list: Shanti Mendis, Jefferson G. Fernandes and E. Moriguchi.
This work on Secondary Prevention of Cronary and Cerebro Vascular Disease, has the contribution of at least three members of th AMICOR list: Shanti Mendis, Jefferson G. Fernandes and E. Moriguchi.
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