The Lancet Neurology
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: terça-feira, 23 de janeiro de 2007 17:28
Para: procor@healthnet.org
Assunto: [ProCOR] Lancet Neurology: Stroke in developing countries: can theepidemic be stopped and outcomes improved?
["Two-thirds of the global burden of stroke occurs in low-income and middle-income countries, but accurate data on stroke incidence in these countries are scarce. Stroke surveillance systems--which are absent in virtually all resource-poor countries--are essential to obtain an accurate picture of the burden of stroke and to enable policymakers to plan cost-effective strategies....There have been attempts to collect reliable data, and there is a will to do so, but the lack of sound methodology and effective surveillance render studies uninformative or incomparable. As an entry point for countries to begin registration of patients with stroke, WHO recommends a stepwise approach to stroke surveillance (STEPS Stroke). This approach enables researchers to gather information on stroke through identification of the three major subsets of patients that comprise a population's stroke burden: those admitted to hospital (step 1); those who have stroke events that are fatal before admission to hospital (step 2); and those with non-fatal strokes who are cared for entirely in the community (step 3). ("STEPS in the right direction," The Lancet Neurology 2007;
6(2): 93).]
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The article below, "Stroke in developing countries: can the epidemic be stopped and outcomes improved?" appears (free full text) in the current issue of The Lancet Neurology. Link to the issue at http://neurology.thelancet.com. For those who cannot access the articles online, excerpts are provided below. We welcome your comments.
To help people who want to establish either hospital-based or population- based stroke registers, WHO provides resources at www.who.int/chp/steps/stroke, including a manual which explains in detail how to develop such a register and an application form/criteria for free access to a Data Entry Tool.
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"Stroke in developing countries: can the epidemic be stopped and outcomes improved?"
Valery L Feigin
Free full text:
http://www.thelancet.com/journals/laneur/article/PIIS1474442207700078/fulltext
Excerpts:
According to WHO estimates, death from stroke in developing (low and
middle-income) countries in 2001 accounted for 85*5% of stroke deaths worldwide, and the number of disability-adjusted life years (DALYs), which comprises years of life lost and years lived with disability, in these countries was almost seven times that in developed (high-income) countries. [1] Stroke burden is likely to increase as a result of ageing and population growth if action is not taken now to remove or reduce the well-established determinants of stroke.
Although good-quality data on the epidemiology, prevention, and management of stroke are rapidly accumulating for economically developed countries, particularly over the past two decades, there is a lack of reliable data for developing countries. These issues and the future of applied stroke research and implementation strategies in these countries are the focus of a series of Review articles, the first of which is published in this issue of The Lancet Neurology.
On the basis of the recent WHO re-assessments of the original Global Burden of Disease (GBD) study and the WHO 2002 mortality estimates, with substantial improvements in data availability and some new methods for dealing with incomplete and biased data, Strong and colleagues [2] review current and projected stroke mortality and burden (as measured in DALYs) for the world, World Bank income groups, and selected countries for the period from 2005 to 2030. The authors estimate that the current global burden of stroke is 16 million first-ever strokes, 62 million stroke survivors, 51 million DALYs, and
5*7 million deaths in 2005. Without additional population-wide interventions, figures are predicted to increase to a staggering 23 million first-ever strokes,
77 million stroke survivors, 61 million DALYs, and 7*8 million deaths by 2030.
Strong and colleagues' data also show that stroke is already a leading cause of death and disability in low and middle-income countries and in the global population under age 70 years, and that 87% of global stroke mortality in 2005 (a 1*5% increase compared with 2001) occurred in these countries, with Russia at the top of the list.
However, if there were a 2% reduction per annum in stroke mortality (due to better management), this would result in 6*4 million fewer deaths from stroke between 2005 and 2015, with most deaths averted and years of life gained in low and middle-income countries. The experience of high-income countries has shown the feasibility of such reductions. The authors advocate a wider use of early administration of aspirin for ischaemic stroke in low and middle-income countries. However, they also correctly argue that the most important contribution to the reduction of stroke mortality in these countries is likely to come from primary prevention, with the emphasis on the major risk factors common to stroke, heart disease, diabetes, and other chronic diseases.
...
What can we learn from these studies? First, we are witnessing an epidemic of stroke in developing countries. The burden of stroke will be even greater if appropriate measures are not taken. Second, there is a lack of reliable and comparable data on stroke incidence, prevalence, causes, trends, management, and outcomes to inform efficient and sustainable health care and prevention strategies in developing countries. The gap in knowledge on stroke epidemiology between developed and developing countries is also widening. Third, despite apparent differences in the patterns of stroke types and risk factor profiles between developed and developing countries, most occurrences of stroke and cardiovascular disease can be attributed to conventional risk factors, [7,8] and some prevention and management strategies are likely to be equally applicable to all countries and populations. The question is whether we should wait until further evidence on stroke epidemiology, prevention, and management is available from developing countries or act now to stop the stroke epidemic and improve outcomes. On the basis of the available evidence, we should act now. Stroke must be a priority on the health agenda in all countries. This leads us to the next logical questions. How best should we proceed to stop the epidemic and improve stroke outcomes in developing countries, given their very limited resources and many competing demands? How best can we monitor the effects of these interventions at the population level in developing countries? What are the directions of future applied stroke research in these countries?
Given the limited resources available for health care in developing countries, it would be logical to place emphasis on effective population-wide interventions to control or reduce exposure to leading risk factors, such as raised blood pressure, smoking, high cholesterol, low fruit and vegetable intake, physical inactivity, and alcohol excess. [9] Population-wide efforts to reduce salt intake and tobacco use through multiple economic and educational policies and programmes have been suggested as cost-effective primary prevention interventions in developing countries. [7]
Primary prevention measures should be complemented with proven secondary prevention measures, such as early aspirin use in patients with acute ischaemic cerebrovascular events, prescription of blood-pressure-lowering drugs to all patients with stroke, and basic multidisciplinary acute stroke units in hospitals that provide emergency care for patients. Development of consensus statements and national stroke guidelines by recognised experts from the region to address local issues on the basis of the best available evidence should also be encouraged and their use supported. Effective strategies to improve stroke awareness (including campaigns to remove stigma associated with stroke) and training of healthcare workers in the regions need to be developed and implemented on a larger scale. [7,10]
Further research is needed to trial other affordable and potentially widely applicable primary and secondary prevention strategies, such as a polypill containing aspirin, blood-pressure-lowering drugs, statin, and perhaps folic acid. [11] More research also needs to be done to assess indigenous medicines and compare various capacity-building strategies. [7] Emphasis should be placed on effectiveness and efficiency of the interventions in the specific context of developing countries. [7,10] Monitoring of effects of interventions at the population level and obtaining comparable and reliable data on stroke incidence, prevalence, and risk factors in developing countries deserves further attention.
[7,12] The ascertainment of numbers of hospitalised stroke patients in the WHO STEPwise approach to stroke surveillance [13] seems feasible, but the other two suggested steps (ascertainment of fatal stroke events in the same community, and especially the ascertainment of non-fatal, non-hospitalised stroke events in the same community) may be challenging in many low and middle-income countries. An alternative approach for studying stroke incidence and prevalence in countries with very limited resources could include a combination of a stroke prevalence survey (eg, door-to-door study) with a study of death certificates (verbal autopsy procedures) in the same community (figure). The key idea of this approach is that nonfatal first-ever stroke events within the preceding 3 years in the defined population are identified among prevalent cases of stroke (prevalence survey) and then combined in the analysis with fatal first-ever stroke events in the same population for the same study period to calculate cumulative stroke incidence rates. The standard WHO definition of stroke should be used to allow comparisons. [14] This design for studying stroke incidence has been used in Italy [15] and China [16] and shown to be valid. [15]
...
Only through a comprehensive approach, combining applied stroke research with sustainable, affordable and context-specific evidence-based prevention and management strategies will it be possible to stem the global stroke epidemic, improve outcomes, monitor burden, and save millions of lives around the world.
Valery L Feigin
Clinical Trials Research Unit, School of Population Health, The University of Auckland, New Zealand
Wednesday, January 24, 2007
Wednesday, January 17, 2007
Expanding Priorities -- Confronting Chronic Disease in Countries with Low Income
NEJM -- Expanding Priorities -- Confronting Chronic Disease in Countries with Low Income: "In a ceremony held at the New York Public Library on June 26, 2006, Microsoft founder and global health philanthropist Bill Gates expressed his belief that 'there is no reason we can't cure the top 20 diseases.'1 To achieve this ambitious objective, however, international health organizations will need to greatly expand their efforts, especially in low-income countries, to prevent and treat noncommunicable chronic diseases.
Although there are many ways to classify diseases and to evaluate the burden of disease, it is clear that by any measure, several noncommunicable chronic diseases have a place in the global top 20. For example, cardiovascular disease alone accounts for nearly 30% of all deaths worldwide and 10% of all years of healthy life lost to disease (called 'disability-adjusted life-years'; see graphs).2 In low-income and lower-middle-income countries (countries with a per capita gross national product of less than $3,255 in 2004), the corresponding figures are similar to the global ones — 27% and 9%, respectively."/.../
Although there are many ways to classify diseases and to evaluate the burden of disease, it is clear that by any measure, several noncommunicable chronic diseases have a place in the global top 20. For example, cardiovascular disease alone accounts for nearly 30% of all deaths worldwide and 10% of all years of healthy life lost to disease (called 'disability-adjusted life-years'; see graphs).2 In low-income and lower-middle-income countries (countries with a per capita gross national product of less than $3,255 in 2004), the corresponding figures are similar to the global ones — 27% and 9%, respectively."/.../
Thursday, January 11, 2007
Medicamentos para o SUS (2) - Provocação do Eduardo Costa
De: Eduardo A Costa [mailto:eduacosta@terra.com.br]
Enviada em: sábado, 6 de janeiro de 2007 11:12
Para: Aloyzio Achutti
Assunto: Re: [2333 - AMICOR-06/01/2007]
Caro amigo Achutti e todos AMICOR,
Tenho um gosto particular pela polêmica, isto é, uma visão de um outro ângulo do mesmo fenômeno.
A visão hegemônica, esconde as outras e deixa encoberto o lado oculto da lua, que nesse caso pode ser fácil de deduzir pela superfície que vemos.
Não é o caso na maioria das vezes. O outro lado é oposto. Vive junto e não aparece. É a cara da moeda. Na coroa está o valor.
Pois bem, o MS em 2003 comprava diretamente 5% de seu orçamento em medicamentos, cerca de 1,5 bilhões de reais e em 2006, gastou 4,2 bilhões, quase 3 vezes mais, agora 11% do seu orçamento. Não está incluido o que repassa para tal fim aos estados e muncipios que também gastam de seus orçamentos, nem o subsidio da Farmácia Popular.
Na face mais visível e utilizada para comprovar o cuidado do Governo com a saúde houve um avanço da política social.
O outro lado é o verdadeiro cifrão (pq não volta para a economia do país, não gera empregos, nem é consumido nos botequins e supermercados brasileiros) : crescem a importação de fármacos e medicamentos e o deficit anual de nosso balanço de pagamentos externo do setor saúde é de mais de 4 bilhões de dólares, sendo quase 3 bilhões em medicamentos e vacinas (10%).
Não temos estimativa de quanto aumentou o acesso dos que precisam a medicamentos, mas aumentou marginalmente.
O destino do aumento de orçamento foram medicamentos patenteados, ou seja monopolizados por alguma grande companhia. Essas continuam a bloquear como podem a indústria nacional.
Para exemplificar: no programa de AIDS (170 mil em tratamento) o orçamento desse ano de 2006 para medicamentos foi de 1,2 bilhões de reais. Os laboratórios oficiais que fornecem 80% das unidades farmacêuticas recebem cerca de 25% dos recursos. Os quase 800 milhões vão para a compra para tratar 30 mil pacientes.
Nada contra. O problema é que não dá mais para acreditar que é cientificamente correto (com a conhecida prática dos conflitos de interesses) e a vulnerabilidade do processo decisório de incorporação aos procedimentos dos "consensos" e da tecnoburocracia estatal.
Não podemos deixar de lembrar que, via de regra, os médicos na maioria dos paises são "treinados" sob a forte pripaganda médica direta ou sutil, em congressos e mesmo na faculdade.
Considero urgente uma revisão dos critérios para a prescrição e incorporação dos "medicamentos de uso excepcional", pois aí está o grande rombo.
Nesse email não vou detalhar mais, mas queria justificar o debate que propus.
E mais, defendo também e com bons dados que o controle de preços não é só sobre preços altos, estamos vivendo frequentemente dumping (preços mais baixos) para tirar o estado ou o nacional do mercado. Depois de sós, voam os preços de novo.
Deixo para outra oportunidade contar alguns dados nossos (de Farmanguinhos) e em particular o último episódio com a insulina humana.
Mas, o centro do questionamento técnico de epidemiologistas clínicos deve partir, na minha opinião:
1 - Clara avaliação dos riscos, não só das vantagens (se devidamente e criticamente estabelecidas);
2 - Contrapor riscos relativos a riscos atribuíveis na população.
3 - Vantagem relativa, sobre o tratamento com medicamentos ou alternativas já bem conhecidas;
4 - Procedimentos para a exclusão de terapêuticas das listas ou recomendações.
Sei que para isso deveríamos ter uma farmacovigilância bem alimentada - raramente as suspeitas de reações adversas são comunicadas e a elas se dá o devido destaque na apuração e organização da informação para a ação.
Mas debater o assunto já é bom.
Abraços a todos, bom ano novo
Eduardo Costa
Enviada em: sábado, 6 de janeiro de 2007 11:12
Para: Aloyzio Achutti
Assunto: Re: [2333 - AMICOR-06/01/2007]
Caro amigo Achutti e todos AMICOR,
Tenho um gosto particular pela polêmica, isto é, uma visão de um outro ângulo do mesmo fenômeno.
A visão hegemônica, esconde as outras e deixa encoberto o lado oculto da lua, que nesse caso pode ser fácil de deduzir pela superfície que vemos.
Não é o caso na maioria das vezes. O outro lado é oposto. Vive junto e não aparece. É a cara da moeda. Na coroa está o valor.
Pois bem, o MS em 2003 comprava diretamente 5% de seu orçamento em medicamentos, cerca de 1,5 bilhões de reais e em 2006, gastou 4,2 bilhões, quase 3 vezes mais, agora 11% do seu orçamento. Não está incluido o que repassa para tal fim aos estados e muncipios que também gastam de seus orçamentos, nem o subsidio da Farmácia Popular.
Na face mais visível e utilizada para comprovar o cuidado do Governo com a saúde houve um avanço da política social.
O outro lado é o verdadeiro cifrão (pq não volta para a economia do país, não gera empregos, nem é consumido nos botequins e supermercados brasileiros) : crescem a importação de fármacos e medicamentos e o deficit anual de nosso balanço de pagamentos externo do setor saúde é de mais de 4 bilhões de dólares, sendo quase 3 bilhões em medicamentos e vacinas (10%).
Não temos estimativa de quanto aumentou o acesso dos que precisam a medicamentos, mas aumentou marginalmente.
O destino do aumento de orçamento foram medicamentos patenteados, ou seja monopolizados por alguma grande companhia. Essas continuam a bloquear como podem a indústria nacional.
Para exemplificar: no programa de AIDS (170 mil em tratamento) o orçamento desse ano de 2006 para medicamentos foi de 1,2 bilhões de reais. Os laboratórios oficiais que fornecem 80% das unidades farmacêuticas recebem cerca de 25% dos recursos. Os quase 800 milhões vão para a compra para tratar 30 mil pacientes.
Nada contra. O problema é que não dá mais para acreditar que é cientificamente correto (com a conhecida prática dos conflitos de interesses) e a vulnerabilidade do processo decisório de incorporação aos procedimentos dos "consensos" e da tecnoburocracia estatal.
Não podemos deixar de lembrar que, via de regra, os médicos na maioria dos paises são "treinados" sob a forte pripaganda médica direta ou sutil, em congressos e mesmo na faculdade.
Considero urgente uma revisão dos critérios para a prescrição e incorporação dos "medicamentos de uso excepcional", pois aí está o grande rombo.
Nesse email não vou detalhar mais, mas queria justificar o debate que propus.
E mais, defendo também e com bons dados que o controle de preços não é só sobre preços altos, estamos vivendo frequentemente dumping (preços mais baixos) para tirar o estado ou o nacional do mercado. Depois de sós, voam os preços de novo.
Deixo para outra oportunidade contar alguns dados nossos (de Farmanguinhos) e em particular o último episódio com a insulina humana.
Mas, o centro do questionamento técnico de epidemiologistas clínicos deve partir, na minha opinião:
1 - Clara avaliação dos riscos, não só das vantagens (se devidamente e criticamente estabelecidas);
2 - Contrapor riscos relativos a riscos atribuíveis na população.
3 - Vantagem relativa, sobre o tratamento com medicamentos ou alternativas já bem conhecidas;
4 - Procedimentos para a exclusão de terapêuticas das listas ou recomendações.
Sei que para isso deveríamos ter uma farmacovigilância bem alimentada - raramente as suspeitas de reações adversas são comunicadas e a elas se dá o devido destaque na apuração e organização da informação para a ação.
Mas debater o assunto já é bom.
Abraços a todos, bom ano novo
Eduardo Costa
Saturday, January 06, 2007
AMICOR 10 anos...
Agradeço as menifestações de carinho e sugestões de vários AMICOR.
Enquanto estamos recolhendo novas sugestões e planejando o futuro, gostaria desde já transcrever parte de mansagem recebida do PADRINHO AMICOR (como todos sabem, foi o Eduardo de Azeredo Costa que sugeriu o nome da lista, ao ver que as mensagens começavam sempre com "Caros amigos do coração").
O desafio é válido e provocador. Desde já podemos começar e/ou ir pensando nele.
Um abraço
AA
...
...No dia 12 passado comemorei de maneira singular meus 40 anos de formatura, sem que eu mencionasse isso, inaugurei uma nova área de produção de medicamentos para hipertensão e diabete e homenagiei o Fadul, último Ministro do Jango, que nos deixou um legado fantástico e ignorado na luta contra os negócios excusos das multinacionais dos medicamentos (em geral os susistas o mencionam porque organizou a 3a. conferência nacional de saúde com o tema central na municipalização da atenção básica).
O discurso do Jango na assinatura do decreto que criou o Geifar (grupo executivo da indústria farmacêutica) é de grande atualidade. Impressionante o que não se sabe que ele fez em pouco mais de dois anos, 40 e poucos anos depois: a primeira lista RENAME, o CADE, a normatização da SECEX para coibir o supoerfaturamento e os dumpings das multis, entre outras coisas.
Nas comemorações dos 10 anos do AMICOR tenho uma sugestão a fazer: porque não pensar em estabelecer um debate sobre a incorporação tecnológica ao SUS na área de medicamentos e equipamentos?
A palavra para definir o descalabro hoje é desvairo orientado para proteger as multis e aumentar nossos gastos....... O que v acha de começar na área cardiovascular definindo uma lista boa e deixar os Amicor discutir os pros e contra? Poruqe e quando substituir uma sinvastatina por outra patenteada? Qual a evidência real, etc.
........
Eduardo
Enquanto estamos recolhendo novas sugestões e planejando o futuro, gostaria desde já transcrever parte de mansagem recebida do PADRINHO AMICOR (como todos sabem, foi o Eduardo de Azeredo Costa que sugeriu o nome da lista, ao ver que as mensagens começavam sempre com "Caros amigos do coração").
O desafio é válido e provocador. Desde já podemos começar e/ou ir pensando nele.
Um abraço
AA
...
...No dia 12 passado comemorei de maneira singular meus 40 anos de formatura, sem que eu mencionasse isso, inaugurei uma nova área de produção de medicamentos para hipertensão e diabete e homenagiei o Fadul, último Ministro do Jango, que nos deixou um legado fantástico e ignorado na luta contra os negócios excusos das multinacionais dos medicamentos (em geral os susistas o mencionam porque organizou a 3a. conferência nacional de saúde com o tema central na municipalização da atenção básica).
O discurso do Jango na assinatura do decreto que criou o Geifar (grupo executivo da indústria farmacêutica) é de grande atualidade. Impressionante o que não se sabe que ele fez em pouco mais de dois anos, 40 e poucos anos depois: a primeira lista RENAME, o CADE, a normatização da SECEX para coibir o supoerfaturamento e os dumpings das multis, entre outras coisas.
Nas comemorações dos 10 anos do AMICOR tenho uma sugestão a fazer: porque não pensar em estabelecer um debate sobre a incorporação tecnológica ao SUS na área de medicamentos e equipamentos?
A palavra para definir o descalabro hoje é desvairo orientado para proteger as multis e aumentar nossos gastos....... O que v acha de começar na área cardiovascular definindo uma lista boa e deixar os Amicor discutir os pros e contra? Poruqe e quando substituir uma sinvastatina por outra patenteada? Qual a evidência real, etc.
........
Eduardo
Friday, January 05, 2007
Cardiosource: ACC Clinical Collection on Coronary Syndromes
Cardiosource: "Dec 20, 2006 unlocked content Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndromes: An Electronic Medication Monitoring System (J Am Coll Cardiol)
Dec 20, 2006 unlocked content Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events (J Am Coll Cardiol)
Dec 20, 2006 unlocked content Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction (Arch Intern Med)
Dec 20, 2006 locked content Bupropion is not helpful for long term smoking cessation in patients hospitalized with acute coronary syndrome. (Am J Med)/.../"
Dec 20, 2006 unlocked content Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events (J Am Coll Cardiol)
Dec 20, 2006 unlocked content Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction (Arch Intern Med)
Dec 20, 2006 locked content Bupropion is not helpful for long term smoking cessation in patients hospitalized with acute coronary syndrome. (Am J Med)/.../"
The Year in Cardiology -
The Year in Cardiology - CME Teaching Brief® - MedPage Today: "Additional Acute Coronary Syndrome Coverage
ATLANTA, Jan. 4 -- Among cardiologists, 2006 will be remembered as the year in which the value of tight cholesterol control was confirmed, the value of various vitamin regimens for preventing heart disease was questioned, a once promising lipid therapy was derailed, and enthusiasm for drug-eluting stents was dampened.
The following summary reviews some of the highlights of the year in cardiology. For fuller accounts, links to the individual articles published in MedPage Today have been provided.
How Low Can You Go?
/.../
ATLANTA, Jan. 4 -- Among cardiologists, 2006 will be remembered as the year in which the value of tight cholesterol control was confirmed, the value of various vitamin regimens for preventing heart disease was questioned, a once promising lipid therapy was derailed, and enthusiasm for drug-eluting stents was dampened.
The following summary reviews some of the highlights of the year in cardiology. For fuller accounts, links to the individual articles published in MedPage Today have been provided.
How Low Can You Go?
/.../
FTC Fines Diet Pill Makers Millions for Bogus Claims
FTC Fines Diet Pill Makers Millions for Bogus Claims - CME Teaching Brief® - MedPage Today: "WASHINGTON, Jan. 4 -- The Federal Trade Commission said today that it fined four makers of over-the-counter weight-loss products more than $25 million for false advertising, including a $3.2 million civil penalty against Bayer for claims made for One-A-Day Weight Smart.
FTC chairman Deborah Platt Majoras said the Bayer fine was the largest civil penalty ever levied by the agency.
She added that none of the four products involved -- One-A-Day Weight Smart, Xenadrine EFX, Cortislim, and TrimSpa -- posed a health risk to users. None was removed from store shelves.
The Bayer settlement, which was filed yesterday in U.S. Court in the District of New Jersey, came after Bayer had violated an earlier FTC order directing it to cease what Majoras said were bogus weight loss claims for its Weight Smart product, which added green tea extract to a standard multivitamin compound./.../"
FTC chairman Deborah Platt Majoras said the Bayer fine was the largest civil penalty ever levied by the agency.
She added that none of the four products involved -- One-A-Day Weight Smart, Xenadrine EFX, Cortislim, and TrimSpa -- posed a health risk to users. None was removed from store shelves.
The Bayer settlement, which was filed yesterday in U.S. Court in the District of New Jersey, came after Bayer had violated an earlier FTC order directing it to cease what Majoras said were bogus weight loss claims for its Weight Smart product, which added green tea extract to a standard multivitamin compound./.../"
Wednesday, January 03, 2007
Promotion of Faster Weight Gain in Infants Born Small for Gestational Age. Is There an Adverse Effect on Later Blood Pressure?
Promotion of Faster Weight Gain in Infants Born Small for Gestational Age. Is There an Adverse Effect on Later Blood Pressure?
Atul Singhal, MD, MRCP; Tim J. Cole, PhD, ScD; Mary Fewtrell, MD, MRCP; Kathy Kennedy, MSc; Terence Stephenson, DM, FRCP, FRPCH; Alun Elias-Jones, FRCP, FRCPCH; Alan Lucas, MD, FRCP, FMed Sci
Background—Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age (birth weight 10th percentile).
Methods and Results—Blood pressure was measured at 6 to 8 years in 153 of 299 (51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean (but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula (unadjusted mean difference for diastolic blood pressure, 3.2 mm Hg; 95% CI, 5.8 to 0.5; P0.02) independent of potential confounding factors (adjusted difference, 3.5 mm Hg; P0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.
Conclusions—In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative “overnutrition” in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age. (Circulation. 2007;115:)
Atul Singhal, MD, MRCP; Tim J. Cole, PhD, ScD; Mary Fewtrell, MD, MRCP; Kathy Kennedy, MSc; Terence Stephenson, DM, FRCP, FRPCH; Alun Elias-Jones, FRCP, FRCPCH; Alan Lucas, MD, FRCP, FMed Sci
Background—Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age (birth weight 10th percentile).
Methods and Results—Blood pressure was measured at 6 to 8 years in 153 of 299 (51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean (but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula (unadjusted mean difference for diastolic blood pressure, 3.2 mm Hg; 95% CI, 5.8 to 0.5; P0.02) independent of potential confounding factors (adjusted difference, 3.5 mm Hg; P0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.
Conclusions—In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative “overnutrition” in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age. (Circulation. 2007;115:)
Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke
Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke
A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhD
Executive Summary
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for
heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhD
Executive Summary
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for
heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus
Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus
A Scientific Statement From the American Heart Association and the
American Diabetes Association . John B. Buse, MD, PhD, Co-chair; Henry N. Ginsberg, MD, FAHA, Co-chair; George L. Bakris, MD, FAHA; Nathaniel G. Clark, MD, MS, RD; Fernando Costa, MD, FAHA; Robert Eckel, MD, FAHA; Vivian Fonseca, MD; Hertzel C. Gerstein, MD, MSc, FRCPC; Scott Grundy, MD, FAHA; Richard W. Nesto, MD, FAHA; Michael P. Pignone, MD, MPH; Jorge Plutzky, MD; Daniel Porte, MD; Rita Redberg, MD, FAHA; Kimberly F. Stitzel, MS, RD; Neil J. Stone, MD, FAHA
Abstract—The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ. (Circulation. 2007;115:114-126.)
A Scientific Statement From the American Heart Association and the
American Diabetes Association . John B. Buse, MD, PhD, Co-chair; Henry N. Ginsberg, MD, FAHA, Co-chair; George L. Bakris, MD, FAHA; Nathaniel G. Clark, MD, MS, RD; Fernando Costa, MD, FAHA; Robert Eckel, MD, FAHA; Vivian Fonseca, MD; Hertzel C. Gerstein, MD, MSc, FRCPC; Scott Grundy, MD, FAHA; Richard W. Nesto, MD, FAHA; Michael P. Pignone, MD, MPH; Jorge Plutzky, MD; Daniel Porte, MD; Rita Redberg, MD, FAHA; Kimberly F. Stitzel, MS, RD; Neil J. Stone, MD, FAHA
Abstract—The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ. (Circulation. 2007;115:114-126.)
Triglycerides and the Risk of Coronary Heart Disease
Triglycerides and the Risk of Coronary Heart Disease
10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies
Nadeem Sarwar, MPhil; John Danesh, DPhil; Gudny Eiriksdottir, MSc; Gunnar Sigurdsson, PhD; Nick Wareham, PhD; Sheila Bingham, PhD; S. Matthijs Boekholdt, PhD;
Kay-Tee Khaw, MBBChir; Vilmundur Gudnason, PhD
Background—Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated
meta-analysis of 27 additional prospective studies in general Western populations.
Methods and Results—Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years
apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident
coronary heart disease cases from 262 525 participants in 29 studies.
Conclusions—Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations. (Circulation. 2006;114:&NA;-.)
10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies
Nadeem Sarwar, MPhil; John Danesh, DPhil; Gudny Eiriksdottir, MSc; Gunnar Sigurdsson, PhD; Nick Wareham, PhD; Sheila Bingham, PhD; S. Matthijs Boekholdt, PhD;
Kay-Tee Khaw, MBBChir; Vilmundur Gudnason, PhD
Background—Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated
meta-analysis of 27 additional prospective studies in general Western populations.
Methods and Results—Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years
apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident
coronary heart disease cases from 262 525 participants in 29 studies.
Conclusions—Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations. (Circulation. 2006;114:&NA;-.)
Postraumatic Stress Found Cardiotoxic in Older Veterans - CME Teaching Brief® - MedPage Today
Postraumatic Stress Found Cardiotoxic in Older Veterans - CME Teaching Brief® - MedPage Today: "Postraumatic Stress Found Cardiotoxic in Older Veterans
By Judith Groch, Senior Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
January 02, 2007
Additional Acute Coronary Syndrome Coverage
BOSTON, Jan. 2 -- More severe posttraumatic stress disorder (PTSD) increased the risk of coronary heart disease and myocardial infarction in older male veterans, researchers reported."
By Judith Groch, Senior Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
January 02, 2007
Additional Acute Coronary Syndrome Coverage
BOSTON, Jan. 2 -- More severe posttraumatic stress disorder (PTSD) increased the risk of coronary heart disease and myocardial infarction in older male veterans, researchers reported."
Friday, December 29, 2006
CVD - Calendar - ProCOR
ProCOR - Home Page: "ProCOR's CVD Calendar compiles events taking place globally that are relevant to the prevention of cardiovascular disease in developing countries.
To submit information about an event to the calendar, email details to info@procor.org."
If you like we, from AMICOR, may intermediate the information to insert your programmed scientific activity into the calendar
To submit information about an event to the calendar, email details to info@procor.org."
If you like we, from AMICOR, may intermediate the information to insert your programmed scientific activity into the calendar
How Web 2.0 is changing medicine -- Giustini 333 (7582): 1283 -- BMJ
How Web 2.0 is changing medicine -- Giustini 333 (7582): 1283 -- BMJ: "Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like 'the web as platform' and 'architecture of participation' are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.
What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.
Web 2.0 is primarily about the benefits of easy to use and free internet software./.../"
What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.
Web 2.0 is primarily about the benefits of easy to use and free internet software./.../"
Thursday, December 28, 2006
Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus. A Scientific Statement From the American Heart Association and the Ame
Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus. A Scientific Statement From the American Heart Association and the American Diabetes Association -- Buse et al., 10.1161/CIRCULATIONAHA.106.179294 -- Circulation: "bstract--The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ."
Wednesday, December 27, 2006
Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies -- Sarwar et
Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies -- Sarwar et al., 10.1161/CIRCULATIONAHA.106.637793 -- Circulation: "
Background--Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated meta-analysis of 27 additional prospective studies in general Western populations.
Methods and Results--Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident coronary heart disease cases from 262 525 participants in 29 studies.
Conclusions--Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations.
"Tuesday, December 26, 2006
JAMA -- Theme Issue on Poverty and Human Development: Call for Papers on Interventions to Improve Health Among the Poor, December 27, 2006, Flanagin a
JAMA -- Theme Issue on Poverty and Human Development: Call for Papers on Interventions to Improve Health Among the Poor, December 27, 2006, Flanagin and Winker 296 (24): 2970: "
Poverty is an inveterate consequence and cause of ill health.1 Without financial resources, people cannot pay for basic human needs: food, water, sanitation, housing, and health care services. In addition, poor people often live in poor countries that have limited or deteriorating health care systems and not enough physicians, nurses, and other trained health care workers. Others live in countries with governments that ignore or are too ineffectual to address the health care needs of the poor. Individuals who are poor also lack adequate education to make appropriate decisions about health and prevention of disease and often lack equity and empowerment to attain education, employment, and skills needed to escape the cycle of poverty.
The first of the United Nation's 8 Millennium Development Goals, determined by 189 countries in 2000, is to eradicate extreme poverty and hunger.2 This specific goal is to halve the proportion of people living on less than $1 a day (the World Bank's definition of extreme poverty) and those who suffer from hunger by the year 2015.2-3 This goal cannot be achieved without improving the level of human development—the opportunity to escape poverty through "the choices that come with a sufficient income, an education, good health, and living in a country that is not governed by tyranny"—among the poor.4 Such development requires careful evaluation and study of interventions aimed to address the needs of poor individuals within their unique local conditions and socioeconomic context, with sufficient follow-up to determine whether effects are sustainable.
In 1990, more than 28% of the developing world's population (1.2 billion people) lived in extreme poverty.2-3 By 2002, this proportion had decreased to 19% but still represented more than 1 billion people.2-3 While substantial declines in extreme poverty have been reported for Eastern and Southern Asia between 1990 and 2002 (from a rate of 33% to 14% in Eastern Asia and from 39% to 31% in
Among all regions of the world other measures demonstrate some progress toward achieving the Millennium Development Goals, including declines in the proportion of people with insufficient food and sanitation, increased enrollments in education, increased proportion of women employed, decreases in child mortality rates, increases in measles vaccination rates, and increased proportion of births attended by skilled health care workers.2 Each of these successes will contribute to reducing poverty and promoting human development, but some of this progress has been only marginal and much additional work, aid, funding, and research are needed.2-3,5
Despite huge increases in wealth and prosperity throughout the world in the last several decades, the gap between the wealthy and the poor has widened, with more than 1 billion people still living in extreme poverty.3, 5 The United Nations Human Development Index is a composite of 3 dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment in primary, secondary, and tertiary schools), and having a decent standard of living (measured by purchasing power parity and income).4 According to the most recent report,
Substantial efforts have been directed at reducing poverty, addressing health needs, and ultimately improving human development during the last few decades.3-5 However, much of the early work begun in the 1960s and 1970s lost support in the mid-1980s following severe economic downturns in many poor countries, the demise of previously state-run approaches to development and the provision of health care, and overall pessimism about the ability to actually reduce poverty and provide health care for all.6 In addition, acts of violence, conflicts, and mass disasters have led to social upheaval and long-term displacement, rendering the most basic health care impossible to deliver. Signs of renewed concern and attention began in the late 1990s with recognition by agencies such as the World Bank of the connection between health, poverty reduction, equity, and economic success as well as increased governmental and private aid and funding of research into poverty and health.6 However, most aid still falls far short of promises and what is needed.5
A vast literature discusses poverty and its associations and effects. A recent search of MEDLINE using the key term "poverty" resulted in more than 22 000 citations, while results in Google Scholar included about 1.3 million articles. However, the MEDLINE citations represent less than 0.002% of the database's 14 million total citations.7 Furthermore, despite the large number of articles, the effectiveness of many interventions to improve health in poor countries remains untested and unproven.8 In fact, compared with costly interventions and therapies that are mostly available to those who can pay for them, relatively few health interventions targeted to serve the poor are evidence-based.8 A systematic review of 286 randomized controlled trials (RCTs) on topics relevant to 35 leading causes of global burden of disease published in 6 leading general medical journals in 1999 found that 124 (43%) of these trials addressed 1 of the 35 leading causes of global burden of disease. Of these, ischemic heart disease, HIV/AIDS, and cerebrovascular disease were the most commonly studied.9 One third of these trials studied 1 of 10 top causes of global burden of disease, but 7 (20%) of the leading causes of global burden of disease were not addressed by any trial.
However, progress is being made in efforts to conduct reliable research on the health needs of the poor and to provide evidence-based solutions. Since 1971, 404 reports of RCTs on interventions related to poverty have been included in MEDLINE, with 57% of these published in the last 6 years. Recent studies have examined a range of interventions, some successful and some not, including strategies to reduce inequalities in access to care; microcredit programs; sustainable health care financing alternatives for the poor; strategies to provide access to essential drugs, vaccines, and therapies; strategies to reduce infant and maternal mortality rates; nutritional interventions; behavioral interventions to improve health and adherence with therapeutic regimens and to prevent disease; educational programs; family planning services; interventions to increase access to clean water and sanitation; and primary care treatments for preventable diseases, chronic diseases, and mental health disorders. The success of microcredit was recognized with this year's award of the Nobel Peace Prize to Muhammad Yunus and Grameen Bank for their "efforts to create economic and social development from below."10
To help disseminate research into interventions that specifically address the needs of the poor, JAMA will publish a theme issue on poverty and human development in October 2007. JAMA is 1 of more than 140 scientific journals participating in plans to simultaneously publish papers on this topic under the coordination of the Council of Science Editors.11 For this theme issue, JAMA will consider manuscripts that report original research of interventions targeted to address poverty, hunger, access to care, and prevention of disease that are based on careful consideration and analysis of local context, evidence, and environments and that are directly targeted to serve the poor. We are also interested in assessments of interventions that are both scalable and sustainable. We are primarily interested in receiving reports of randomized or cluster controlled trials, but we will also consider cohort studies, case-control studies, and other observational studies as well as systematic reviews, meta-analyses, and commentaries. Manuscripts received by May 1, 2007, will have the best chance of consideration for the issue. Please see JAMA's Instructions for Authors for information on preparing and submitting manuscripts.12
Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years, December 27, 2006, Carandang et
JAMA -- Abstract: Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years, December 27, 2006, Carandang et al. 296 (24): 2939:
" Context Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported.
" Context Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported.
Objective To determine long-term trends in the incidence, lifetime risk, severity, and 30-day mortality of clinical stroke.
Design, Setting, and Participants Prospective evaluation of the community-based Framingham Study original and offspring cohorts. Participants were 9152 men and women free of prevalent stroke and undergoing follow-up for up to 50 years over 3 consecutive periods (1950-1977, 1978-1989, and 1990-2004), with biennial ascertainment of stroke risk factor data and active surveillance for incident clinical stroke and cause-specific mortality.
Main Outcome Measures Incidence (age-adjusted, sex-specific), severity, 30-day mortality, and mortality-adjusted 10-year and lifetime risk of stroke in each of the specified periods.
Results There were 1030 incident clinical strokes (450 [44%] in men, 629 atherothrombotic brain infarctions [61%]) in 9152 persons 55 years or older over 174 917 person-years of follow-up. The age-adjusted incidence of first stroke per 1000 person-years in each of the 3 periods was 7.6, 6.2, and 5.3, respectively, in men (P = .02 for trend) and 6.2, 5.8, and 5.1 in women (P = .01 for trend). The lifetime risk at age 65 years decreased from 19.5% to 14.5% in men (P = .11) and from 18.0% to 16.1% in women (P = .61). Age-adjusted stroke severity did not vary across periods; however, 30-day mortality decreased significantly in men (from 23% to 14%; P = .01) but not significantly in women (from 21% to 20%; P = .32).
Conclusions In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts. "Saturday, December 23, 2006
CVD Surveillance System toward prevention
A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhDA strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive
and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations
for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
Overarching Recommendations
1. A National Heart Disease and Stroke Surveillance unit should be established to produce annual reports on key indicators of progress in the prevention and management of heart disease and stroke. P I, S I, C $.
2. Cardiovascular disease (CVD), including cardiac arrests, acute coronary syndromes (heart attack and unstable angina), stroke, chronic heart failure (CHF), and related interventional procedures, should be classified as reportable conditions. P I, S III (although developmental
work should begin earlier), C $$$.
3. Data collection about patients’ encounters with the healthcare system should be revised to include collection of data on lipoprotein cholesterol concentrations, blood sugar, and glycohemoglobin values. P I, S I, C $.
4. Data elements should be standardized across surveys, and unnecessary duplication in data sources should be avoided. P I, S I, C $ (potentially cost saving).
5. The design and conduct of nationally representative surveillance programs should be revised to facilitate oversampling by states, territories, and tribal organizations and to provide meaningful estimates on ethnic subgroups in the populations. Sampling within states, territories, and tribal organizations should be designed to facilitate oversampling by counties. P I, S
II, C $$ to $$$ (depending on extent of oversampling achieved).
6. Mechanisms should be developed to enable linkage between healthcare data systems, including the national surveillance programs (eg, National Ambulatory Medical Care Survey [NAMCS], National Hospital Discharge Survey [NHDS], and National Death Index), and
electronic health records. P I, S II, C $$$ (startup) and $$ (maintenance).
7. Studies are needed to establish the validity of multiple measures collected by self-report and provider report in national databases. P II, S II, C $$.
Thursday, December 14, 2006
More mystery deaths than thought
BBC NEWS | Health | More mystery deaths than thought: "he rate of sudden unexplained deaths in England is around eight times higher than previously thought, warn experts.
Around 500 people may die every year from sudden arrhythmic death syndrome, a study published in Heart shows.
SADS is linked to a genetic heart defect and family members should be screened to prevent more deaths, the researchers said.
The study also found that only one-third of cases had been correctly identified by post-mortem.
The researchers identified 56 cases of SADS from 115 coroners' reports of unascertained causes of death."
Around 500 people may die every year from sudden arrhythmic death syndrome, a study published in Heart shows.
SADS is linked to a genetic heart defect and family members should be screened to prevent more deaths, the researchers said.
The study also found that only one-third of cases had been correctly identified by post-mortem.
The researchers identified 56 cases of SADS from 115 coroners' reports of unascertained causes of death."
Sunday, December 10, 2006
'Fat scan' shows up health risk
BBC NEWS Health 'Fat scan' shows up health risk: "Hammersmith Hospital, in west London, is currently the only hospital in Europe using the MRI scan.
Its scientists say 40% of the population have 'bad' fat around the heart, liver or pancreas, even though many appear thin.
They warn it is possible to be slim and yet still be at risk of conditions like diabetes because of 'hidden' fat.
Evidence suggests the precise location of fat has more of a bearing on health than simply being overweight. "
Its scientists say 40% of the population have 'bad' fat around the heart, liver or pancreas, even though many appear thin.
They warn it is possible to be slim and yet still be at risk of conditions like diabetes because of 'hidden' fat.
Evidence suggests the precise location of fat has more of a bearing on health than simply being overweight. "
Tuesday, December 05, 2006
Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution -- Pope et al. 114 (23): 2443 -- Circulation
Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution -- Pope et al. 114 (23): 2443 -- Circulation: "Background— Recent evidence suggests that long-term exposure to particulate air pollution contributes to pulmonary and systemic oxidative stress, inflammation, progression of atherosclerosis, and risk of ischemic heart disease and death. Short-term exposure may contribute to complications of atherosclerosis, such as plaque vulnerability, thrombosis, and acute ischemic events. These findings are inconclusive and controversial and require further study. This study evaluates the role of short-term particulate exposure in triggering acute ischemic heart disease events.
Methods and Results— A case-crossover study design was used to analyze ischemic events in 12 865 patients who lived on the Wasatch Front in Utah. Patients were drawn from the cardiac catheterization registry of the Intermountain Heart Collaborative Study, a large, ongoing registry of patients who underwent coronary arteriography and were followed up longitudinally. Ambient fine particulate pollution (particles with an aerodynamic diameter ≤2.5 µm; PM2.5) elevated by 10 µg/m3 was associated with increased risk of acute ischemic coronary events (unstable angina and myocardial infarction) equal to 4.5% (95% confidence interval, 1.1 to 8.0). Effects were larger for those with angiographically demonstrated/.../"
Methods and Results— A case-crossover study design was used to analyze ischemic events in 12 865 patients who lived on the Wasatch Front in Utah. Patients were drawn from the cardiac catheterization registry of the Intermountain Heart Collaborative Study, a large, ongoing registry of patients who underwent coronary arteriography and were followed up longitudinally. Ambient fine particulate pollution (particles with an aerodynamic diameter ≤2.5 µm; PM2.5) elevated by 10 µg/m3 was associated with increased risk of acute ischemic coronary events (unstable angina and myocardial infarction) equal to 4.5% (95% confidence interval, 1.1 to 8.0). Effects were larger for those with angiographically demonstrated/.../"
Sunday, December 03, 2006
Pfizer Ends Studies on Drug for Heart Disease - New York Times
Pfizer Ends Studies on Drug for Heart Disease - New York Times:
By ALEX BERENSON
Published: December 3, 2006
"Pfizer announced last night that it had discontinued research on its most important experimental drug, a treatment for heart disease. The decision is a stunning development that is likely to seriously damage the company’s prospects through the next decades.
Preliminary research found that the drug, torcetrapib, appeared to be linked with deaths and heart problems in the patients who were taking it.
For people with heart disease, Pfizer’s decision to stop the trial represents the failure of a drug that many cardiologists had viewed as a potentially major advance in efforts to reduce heart attacks and strokes.
Torcetrapib is designed to raise levels of so-called good cholesterol. It was to be used in combination with older drugs called statins, like Lipitor and Zocor, which reduce so-called bad cholesterol.
As recently as Thursday, Pfizer executives had hailed the drug at a meeting with investors and analysts at the company’s research center in Groton, Conn.
“This will be one of the most important compounds of our generation,” said Jeffrey B. Kindler, Pfizer’s chief executive.
Pfizer is the world’s biggest drug company, with 106,000 employees and $51 billion in sales in 2005."
By ALEX BERENSON
Published: December 3, 2006
"Pfizer announced last night that it had discontinued research on its most important experimental drug, a treatment for heart disease. The decision is a stunning development that is likely to seriously damage the company’s prospects through the next decades.
Preliminary research found that the drug, torcetrapib, appeared to be linked with deaths and heart problems in the patients who were taking it.
For people with heart disease, Pfizer’s decision to stop the trial represents the failure of a drug that many cardiologists had viewed as a potentially major advance in efforts to reduce heart attacks and strokes.
Torcetrapib is designed to raise levels of so-called good cholesterol. It was to be used in combination with older drugs called statins, like Lipitor and Zocor, which reduce so-called bad cholesterol.
As recently as Thursday, Pfizer executives had hailed the drug at a meeting with investors and analysts at the company’s research center in Groton, Conn.
“This will be one of the most important compounds of our generation,” said Jeffrey B. Kindler, Pfizer’s chief executive.
Pfizer is the world’s biggest drug company, with 106,000 employees and $51 billion in sales in 2005."
Saturday, December 02, 2006
Natural History of Atherosclerosis: A Critical Evaluation of the Current Understanding of the Natural History of Human Atherosclerosis
Natural History of Atherosclerosis: A Critical Evaluation of the Current Understanding of the Natural History of Human Atherosclerosis
At a 2004 meeting in Paris, Renu Virmani, MD, FACC, medical director and founder of CVPath Institute, Gaithersburg, Maryland, warned that drug-eluting stents (DESs) could increase the risk of late thrombosis leading to MIs months or even years after the stents were implanted. Despite pathology slides vividly showing the victims’ stents totally occluded by clots, few of her colleagues showed much interest in her warning. Yet subsequent analyses of clinical trial and registry data suggest that late thrombosis is seen more often with DES placement than with older bare-metal stents (BMSs). The data – summarized in an AHA ’06 report featuring Robert S. Schwartz, MD, FACC (click here) – have renewed interest in the natural history of human atherosclerosis and what can be done clinically to reduce the risk of late thrombosis.
At a 2004 meeting in Paris, Renu Virmani, MD, FACC, medical director and founder of CVPath Institute, Gaithersburg, Maryland, warned that drug-eluting stents (DESs) could increase the risk of late thrombosis leading to MIs months or even years after the stents were implanted. Despite pathology slides vividly showing the victims’ stents totally occluded by clots, few of her colleagues showed much interest in her warning. Yet subsequent analyses of clinical trial and registry data suggest that late thrombosis is seen more often with DES placement than with older bare-metal stents (BMSs). The data – summarized in an AHA ’06 report featuring Robert S. Schwartz, MD, FACC (click here) – have renewed interest in the natural history of human atherosclerosis and what can be done clinically to reduce the risk of late thrombosis.
Acute rheumatic fever is still a clinical challenge -- 333 (7579): 0 -- BMJ
Acute rheumatic fever is still a clinical challenge -- 333 (7579): 0 -- BMJ: "BMJ 2006;333 (2 December), doi:10.1136/bmj.333.7579.0-b
Related Article
This week in the BMJ
Acute rheumatic fever is still a clinical challenge
Acute rheumatic fever, now rare in high income populations, remains highly prevalent in developing countries where access to health care is poor, says Cilliers (doi: 10.1136/bmj.39031.420637.BE) in her clinical review. Although it is known to be caused by humoral and cell mediated immune responses to group A beta haemolytic streptococcus antigens, the syndrome of carditis, polyarthritis, and skin or neurological changes is still not completely understood. Only 0.3-3% of patients with acute streptococcal pharyngitis develop rheumatic fever and a genetic predisposition is certain.
Related Article
Rheumatic fever and its management
Antoinette M CilliersBMJ 2006 333: 1153-1156. [Extract] [Full Text]
Related Article
This week in the BMJ
Acute rheumatic fever is still a clinical challenge
Acute rheumatic fever, now rare in high income populations, remains highly prevalent in developing countries where access to health care is poor, says Cilliers (doi: 10.1136/bmj.39031.420637.BE) in her clinical review. Although it is known to be caused by humoral and cell mediated immune responses to group A beta haemolytic streptococcus antigens, the syndrome of carditis, polyarthritis, and skin or neurological changes is still not completely understood. Only 0.3-3% of patients with acute streptococcal pharyngitis develop rheumatic fever and a genetic predisposition is certain.
Related Article
Rheumatic fever and its management
Antoinette M CilliersBMJ 2006 333: 1153-1156. [Extract] [Full Text]
Tuesday, November 28, 2006
Childhood Poverty Grows into Adult Heart Disease
Childhood Poverty Grows into Adult Heart Disease - CME Teaching Brief® - MedPage Today: ", Nov. 27 -- A poor childhood more than doubles the risk of early heart disease among white male physicians who achieve a high socioeconomic status, found researchers here. Action Points
Explain to patients who ask that this study suggests that relative poverty in childhood has a persistent effect and increases the risk of heart disease as adults among white male physicians who achieve high socioeconomic status.
Point out that this increased risk is not mediated by established coronary heart disease risk factors.
The finding, based on a long-running prospective study of the precursors of heart disease, underlines the persistent effect of relative poverty on children's future health, according to Michelle Kittleson, M.D., Ph.D., of Johns Hopkins.
Interestingly, the effect appears to moderate over time, as other risk factors for coronary heart disease begin to predominate with increasing age, Dr. Kittleson (now at the UCLA) and colleagues reported in the Nov. 27 issue of Archives of Internal Medicine.
Dr. Kittleson and colleagues analyzed data from the John Hopkins Precursors Study, which enrolled graduates of the university's medical school between 1948 and 1964. Median follow-up has reached 40 years.
The cohort was valuable to examine the effects of childhood socioeconomic status, Dr. Kittleson and colleagues said, because it eliminated a key adult confounding effect. All of the participants went on to enjoy the income and professional status of physicians.
For this analysis, the researchers excluded female graduates, those of non-European background, those who did not provide information about parental occupation, and those who were unavailable for follow-up, leaving 1,131 volunteers."
Explain to patients who ask that this study suggests that relative poverty in childhood has a persistent effect and increases the risk of heart disease as adults among white male physicians who achieve high socioeconomic status.
Point out that this increased risk is not mediated by established coronary heart disease risk factors.
The finding, based on a long-running prospective study of the precursors of heart disease, underlines the persistent effect of relative poverty on children's future health, according to Michelle Kittleson, M.D., Ph.D., of Johns Hopkins.
Interestingly, the effect appears to moderate over time, as other risk factors for coronary heart disease begin to predominate with increasing age, Dr. Kittleson (now at the UCLA) and colleagues reported in the Nov. 27 issue of Archives of Internal Medicine.
Dr. Kittleson and colleagues analyzed data from the John Hopkins Precursors Study, which enrolled graduates of the university's medical school between 1948 and 1964. Median follow-up has reached 40 years.
The cohort was valuable to examine the effects of childhood socioeconomic status, Dr. Kittleson and colleagues said, because it eliminated a key adult confounding effect. All of the participants went on to enjoy the income and professional status of physicians.
For this analysis, the researchers excluded female graduates, those of non-European background, those who did not provide information about parental occupation, and those who were unavailable for follow-up, leaving 1,131 volunteers."
Monday, November 27, 2006
The polypill: at what price would it become cost effective? -- Franco et al. 60 (3): 213 -- Journal of Epidemiology and Community Health
The polypill: at what price would it become cost effective? -- Franco et al. 60 (3): 213 -- Journal of Epidemiology and Community Health: "Introduction: A promising concept in cardiovascular disease prevention (the polypill) was introduced in 2003. Although the polypill may seem as an effective intervention, data on its costs and cost effectiveness remain unknown. The aim of this study was to determine the maximum price of the polypill for it to be a cost effective alternative in the primary prevention of cardiovascular disease.
Methods: Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a 20 000/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age.
Results: To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than 302 or 410 for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower.
Conclusion: Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in the primary prevention of cardiovascular disease. "
Methods: Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a 20 000/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age.
Results: To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than 302 or 410 for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower.
Conclusion: Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in the primary prevention of cardiovascular disease. "
Saturday, November 25, 2006
Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational obs
Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) -- Fox et al. 333 (7578): 1091 -- BMJ: "Objective To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infarction to facilitate triage and management of patients with acute coronary syndrome. Design Prospective multinational observational study in which we used multivariable regression to develop a final predictive model, with prospective and external validation. Setting Ninety four hospitals in 14 countries in Europe, North and South America, Australia, and New Zealand. Population 43 810 patients (21 688 in derivation set; 22 122 in validation set) presenting with acute coronary syndrome with or without ST segment elevation enrolled in the global registry of acute coronary events (GRACE) study between April 1999 and September 2005. Main outcome measures Death and myocardial infarction. Results 1989 patients died in hospital, 1466 died between discharge and six month follow-up, and 2793 sustained a new non-fatal myocardial infarction. Nine factors independently predicted death and the combined end point of death or myocardial infarction in the period from admission to six months after discharge: age, development (or history) of heart failure, peripheral vascular disease, systolic blood pressure, Killip class, initial serum creatinine concentration, elevated initial cardiac markers, cardiac arrest on admission, and ST segment deviation. The simplified model was robust, with prospectively validated C-statistics of 0.81 for predicting death and 0.73 for death or myocardial infarction from admission to six months after discharge. The external applicability of the model was validated in the dataset from GUSTO IIb (global use of strategies to open occluded coronary arteries). Conclusions This risk prediction tool uses readily identifiable variables to provide robust prediction of the cumulative six month risk of death or myocardial infarction. It is a rapid and widely applicable method for assessing cardiovascular risk to complement clinical assessment and can guide patient triage and management across the spectrum of patients with acute coronary syndrome. "
Thursday, November 23, 2006
Time course of depression and outcome of myocardial infarction.
De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: quinta-feira, 23 de novembro de 2006 00:50
Arch Intern Med. 2006 Oct 9;166(18):2035-43.
Time course of depression and outcome of myocardial infarction.
Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A, Weintraub WS, Lichtman J, Dawood N, Vaccarino V.
Divisions of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. smallik@emory.edu
BACKGROUND: Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI. METHODS: In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire). RESULTS: Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P<.05). Corresponding odds ratios were 1.62, 2.73, and
2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.
CONCLUSION: Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.
Publication Types:
Multicenter Study
PMID: 17030839 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=17030839&dopt=Abstract
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco
Enviada em: quinta-feira, 23 de novembro de 2006 00:50
Arch Intern Med. 2006 Oct 9;166(18):2035-43.
Time course of depression and outcome of myocardial infarction.
Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A, Weintraub WS, Lichtman J, Dawood N, Vaccarino V.
Divisions of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. smallik@emory.edu
BACKGROUND: Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI. METHODS: In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire). RESULTS: Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P<.05). Corresponding odds ratios were 1.62, 2.73, and
2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.
CONCLUSION: Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.
Publication Types:
Multicenter Study
PMID: 17030839 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=17030839&dopt=Abstract
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco
Researchers isolate a master heart cell
Researchers isolate a master heart cell - The Boston Globe: "A team of Harvard scientists announced yesterday that it has discovered a single kind of cell that builds the three main types of heart tissue, an advance that boosts the prospects of using cells to treat heart disease, the nation's top killer.
The team identified the heart cell in mice, and proved that it develops into the muscle cells that power the heart, the cells that make up blood vessels, and the smooth muscle cells that allow the vessels to expand and contract.
If the human equivalent of the new cells is found, it could be given to patients to rebuild heart tissue that cannot be repaired today. The work could also give biologists new tools to look for heart drugs.
There has been a rush of work in recent years to develop therapies that inject cells capable of repairing patients' damaged heart muscle. But the field has been hampered because biologists have not known what type of cell to use. Researchers around the world have launched clinical trials, but the trials have used blood cells, not heart cells, and the results have been modest, at best.
The research identifies, for the first time, a kind of master heart cell, similar to a stem cell, with a proven ability to build a wide range of heart tissues. The scientists cautioned that important obstacles remain before cell therapies based on the research can be tested in humans."
The team identified the heart cell in mice, and proved that it develops into the muscle cells that power the heart, the cells that make up blood vessels, and the smooth muscle cells that allow the vessels to expand and contract.
If the human equivalent of the new cells is found, it could be given to patients to rebuild heart tissue that cannot be repaired today. The work could also give biologists new tools to look for heart drugs.
There has been a rush of work in recent years to develop therapies that inject cells capable of repairing patients' damaged heart muscle. But the field has been hampered because biologists have not known what type of cell to use. Researchers around the world have launched clinical trials, but the trials have used blood cells, not heart cells, and the results have been modest, at best.
The research identifies, for the first time, a kind of master heart cell, similar to a stem cell, with a proven ability to build a wide range of heart tissues. The scientists cautioned that important obstacles remain before cell therapies based on the research can be tested in humans."
Tuesday, November 21, 2006
Extending the Horizon in Chronic Heart Failure. Effects of Multidisciplinary, Home-Based Intervention Relative to Usual Care -- Inglis et al., 10.1161
Background--The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown.
Methods and Results--The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions; P<0.05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI.
Conclusions--In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
Methods and Results--The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions; P<0.05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI.
Conclusions--In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
Risk Factors Socioeconomic status
Impact of Traditional and Novel Risk Factors on the Relationship Between Socioeconomic Status and Incident Cardiovascular Events -- Albert et al., 10.1161/CIRCULATIONAHA.106.660043 -- Circulation: "Background--Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events. Methods and Results--We assessed the relationship between 2 indicators of socioeconomic status (education and income), traditional and novel CVD risk factors (high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22 688 apparently healthy female health professionals participating in the Women’s Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (<2 trend="0.006),">Conclusions--In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD."
Alzheimer's heart link explained
BBC NEWS Health Alzheimer's heart link explained: "Both conditions lead to a reduction of oxygen flow to the brain.
A University of British Columbia team, studying mice, found this stimulates increased development of the protein clumps thought to cause Alzheimer's.
The lack of oxygen increases activity in a gene controlling production of the key protein, found the Proceedings of the National Academy of Sciences study. "
A University of British Columbia team, studying mice, found this stimulates increased development of the protein clumps thought to cause Alzheimer's.
The lack of oxygen increases activity in a gene controlling production of the key protein, found the Proceedings of the National Academy of Sciences study. "
Sunday, November 19, 2006
cocoa's medicinal potential
The Standard - Mars talks up cocoa's medicinal potential - World Section: "Mars is holding ''serious discussions with large pharmaceutical companies'' about the development of a line of cocoa-based prescription drugs that could help treat diabetes, some forms of dementia and other ailments. "
Thursday, November 16, 2006
Novel Drug Effective for Hyponatremia in Heart Failure Patients
AHA: Novel Drug Effective for Hyponatremia in Heart Failure Patients - CME Teaching Brief® - MedPage Today: "CHICAGO, Nov. 15 -- Tolvaptan, an investigational selective oral vasopressin V2-receptor antagonist, restored serum sodium concentrations in heart failure and cirrhosis patients with hyponatremia, researchers reported here.
Compared with placebo patients in randomized, double blind studies of patients with euvolemic or hypervolemic hyponatremia, serum sodium concentrations increased in the tolvaptan arm by day four and the rise was durable at 30 days (P<0.001), said Mihai Gheorghiade, M.D., of Northwestern University. "
Compared with placebo patients in randomized, double blind studies of patients with euvolemic or hypervolemic hyponatremia, serum sodium concentrations increased in the tolvaptan arm by day four and the rise was durable at 30 days (P<0.001), said Mihai Gheorghiade, M.D., of Northwestern University. "
Tuesday, November 07, 2006
High Uric Acid Levels Signal Hypertension in Blacks
High Uric Acid Levels Signal Hypertension in Blacks - CME Teaching Brief® - MedPage Today:
Primary source: HypertensionSource reference: Mellen PB et al. "Serum Uric Acid Predicts Incident Hypertension in a Biethnic Cohort: The Atherosclerosis Risk in Communities Study." Hypertension. 2006;48:1-6. DOI: 10.1161/01.HYP.0000249768.26560.66
"WINSTON-SALEM, N.C., Nov. 6 -- High serum levels of uric acid are strongly associated with risk for hypertension, particularly among blacks, according to researchers here."
Primary source: HypertensionSource reference: Mellen PB et al. "Serum Uric Acid Predicts Incident Hypertension in a Biethnic Cohort: The Atherosclerosis Risk in Communities Study." Hypertension. 2006;48:1-6. DOI: 10.1161/01.HYP.0000249768.26560.66
"WINSTON-SALEM, N.C., Nov. 6 -- High serum levels of uric acid are strongly associated with risk for hypertension, particularly among blacks, according to researchers here."
Wednesday, November 01, 2006
How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?
PLoS Medicine: How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?: "I is well established that diabetes mellitus is associated with adverse health outcomes. Data from general population cohorts indicate a 2- to 3-fold increase in cardiovascular risks and about a 50 percent increase in the risks of non-cardiovascular mortality associated with this condition [1–3]. These associations appear largely consistent across populations in different regions of the world [3].
There is some evidence that diabetes may be a more important determinant of cardiovascular risk for women than men [4]. However, the relative effects of diabetes on vascular and other diseases among older, compared with younger, individuals is less certain. Heterogeneity by age in the association between diabetes and cardiovascular disease has been reported, with a consistently weaker association observed among older individuals [3,5]. Given this possible age-dependency in the epidemiological associations, and the frequent observation that cardiovascular risk factors are often managed less aggressively in older people than in younger people [6], a better understanding of the relationship between diabetes and disease-specific causes of death among older people is important./.../"
There is some evidence that diabetes may be a more important determinant of cardiovascular risk for women than men [4]. However, the relative effects of diabetes on vascular and other diseases among older, compared with younger, individuals is less certain. Heterogeneity by age in the association between diabetes and cardiovascular disease has been reported, with a consistently weaker association observed among older individuals [3,5]. Given this possible age-dependency in the epidemiological associations, and the frequent observation that cardiovascular risk factors are often managed less aggressively in older people than in younger people [6], a better understanding of the relationship between diabetes and disease-specific causes of death among older people is important./.../"
Tuesday, October 31, 2006
Atividade Física e Saúde CV
Enviado por: Timóteo Leandro de Araújo [timoteo@celafiscs.org.br]
Gostaria de perguntar sobre alguma informação ou tema sobre o impacto da Prática da Atividade na reunião do SBC?
Encaminho a agenda dos programas que estamos colaborando com a TV Cultura em SP nessa sexta-feira será discutido a AF x Infarto.
Um grande abraço.
dia 03/11 – pgm 15 – AF X prevenção do infarto do miocárdio ( Claudia Forjaz / Dr. Nabil Ghaorayeb / Dr. José Aguilar Cortez)
dia 10/11 – pgm 16 – caminhada + promoção saúde ( Timóteo Araújo / Erinaldo Andrade)
dia 17/11 – pgm 17 – atividade física no setor privado (Dr. Márcio Marega)
dia 24/11 – pgm 18 – atividade física e hipertensão (Dr. Celso Amadeo)
dia 01/12 – pgm 19 – atividade física no setor públici de saúde (Dra. Marizete Medeiros)
dia 08/12 – pgm 20 – atividade física nas Ongs (Dr. Mário Albanese)
Prof. Timóteo Araújo
Gostaria de perguntar sobre alguma informação ou tema sobre o impacto da Prática da Atividade na reunião do SBC?
Encaminho a agenda dos programas que estamos colaborando com a TV Cultura em SP nessa sexta-feira será discutido a AF x Infarto.
Um grande abraço.
dia 03/11 – pgm 15 – AF X prevenção do infarto do miocárdio ( Claudia Forjaz / Dr. Nabil Ghaorayeb / Dr. José Aguilar Cortez)
dia 10/11 – pgm 16 – caminhada + promoção saúde ( Timóteo Araújo / Erinaldo Andrade)
dia 17/11 – pgm 17 – atividade física no setor privado (Dr. Márcio Marega)
dia 24/11 – pgm 18 – atividade física e hipertensão (Dr. Celso Amadeo)
dia 01/12 – pgm 19 – atividade física no setor públici de saúde (Dra. Marizete Medeiros)
dia 08/12 – pgm 20 – atividade física nas Ongs (Dr. Mário Albanese)
Prof. Timóteo Araújo
Monday, October 30, 2006
61. Congresso Brasileiro de Cardiologia
Estivemos em Recife participando do 61 Congresso da SBC.
Entre tantas oportunidades de contato e troca de conhecimento e experiências que podem ser visitados no endereço da SBC e no Congresso Virtual, gostaria de registrar com satisfação a premiação de membros da lista AMICOR: Geniberto Paiva Campos, Carisi Polanckzyc, Nadine Clasusell juntamente com o esposo da Dra. Carisi, Dr. Rohde.
Também gostaria de assinalar que entre os candidatos à presidência da SBC constam ilustres AMICOR: Abrahão Afiune Neto, Flávio Danni Fuchs, Jorge Ilha Guimarães e Paulo César B. Jardim.
Juntamente com vários outros membros de nossa lista tive a satisfação de participar de três atividades:
Entre tantas oportunidades de contato e troca de conhecimento e experiências que podem ser visitados no endereço da SBC e no Congresso Virtual, gostaria de registrar com satisfação a premiação de membros da lista AMICOR: Geniberto Paiva Campos, Carisi Polanckzyc, Nadine Clasusell juntamente com o esposo da Dra. Carisi, Dr. Rohde.
Também gostaria de assinalar que entre os candidatos à presidência da SBC constam ilustres AMICOR: Abrahão Afiune Neto, Flávio Danni Fuchs, Jorge Ilha Guimarães e Paulo César B. Jardim.
Juntamente com vários outros membros de nossa lista tive a satisfação de participar de três atividades:
- Abrindo com uma palestra a primeira sessão de temas livres sobre Epidemiologia, abordando "Ultrapassando o Setor Saúde"
- Coordenando e traçando retrato do tabagismo no BR no simpósio sobre "Tabagismo: Doença Negligenciada" com Analice Gigliotti, Jacqueline Issa e José Miguel Chatkin
- Participando de Sessão Especial sobre Tabagismo Passivo, juntamente com Aristóteles Comte de Alencar Fo. Jacqueline Scholz Issa e Silvia Maria Cury Ismael.
ICMJE - Uniform Requirements for Manuscripts Submitted to Biomedical Journals
ICMJE - Uniform Requirements for Manuscripts Submitted to Biomedical Journals:
(Recebido de Fábio Vilas-Boas, Editor dos Arquivos Brasileiros de Cardiologia)
"A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE gradually has broadened its concerns to include ethical principles related to publication in biomedical journals./.../"
(Recebido de Fábio Vilas-Boas, Editor dos Arquivos Brasileiros de Cardiologia)
"A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE gradually has broadened its concerns to include ethical principles related to publication in biomedical journals./.../"
Tuesday, October 17, 2006
How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?
PLoS Medicine: How Important Is Diabetes as a Risk Factor for Cardiovascular and Other Diseases in Older Adults?: "Clinical Implications
So what are the implications of the results of this study for clinical practice? Primarily, these data confirm that older adults with diabetes are at very high absolute risk of death from cardiovascular causes (four to five percent per year). Thus, strategies aimed at reducing these risks should be aggressively pursued among such individuals, wherever possible.
Fortunately, a range of preventive treatments of proven efficacy are at our disposal, including blood pressure lowering [9] and the use of statins [10]. Intensive glucose lowering in type 2 diabetes has been shown to reduce microvascular (retinal and renal) events. However, the balance of risks and benefits of lowering haemoglobin A1c levels below seven percent (as recommended by many current guidelines), particularly with respect to macrovascular events such as myocardial infarction and stroke, remains uncertain. At least two large-scale randomised clinical trials evaluating this question are ongoing, one of which has no upper age restriction [11] while the other includes participants aged up to 80 years at randomisation [12]. Importantly, to reach such targets for intensive glucose lowering, insulin therapy will be frequently required. Should the trials demonstrate that the benefits of intensive glucose lowering outweigh the risks, these data, rather than observational data suggesting possible harm associated with the use of insulin, should take precedence in guiding clinical practice."
So what are the implications of the results of this study for clinical practice? Primarily, these data confirm that older adults with diabetes are at very high absolute risk of death from cardiovascular causes (four to five percent per year). Thus, strategies aimed at reducing these risks should be aggressively pursued among such individuals, wherever possible.
Fortunately, a range of preventive treatments of proven efficacy are at our disposal, including blood pressure lowering [9] and the use of statins [10]. Intensive glucose lowering in type 2 diabetes has been shown to reduce microvascular (retinal and renal) events. However, the balance of risks and benefits of lowering haemoglobin A1c levels below seven percent (as recommended by many current guidelines), particularly with respect to macrovascular events such as myocardial infarction and stroke, remains uncertain. At least two large-scale randomised clinical trials evaluating this question are ongoing, one of which has no upper age restriction [11] while the other includes participants aged up to 80 years at randomisation [12]. Importantly, to reach such targets for intensive glucose lowering, insulin therapy will be frequently required. Should the trials demonstrate that the benefits of intensive glucose lowering outweigh the risks, these data, rather than observational data suggesting possible harm associated with the use of insulin, should take precedence in guiding clinical practice."
Investigational Drug Converts Afib to Sinus Rhythm
Teaching Brief® - MedPage Today: "NEW ORLEANS Oct. 16 -- For converting atrial fibrillation to sinus rhythm in patients on rate-control or rhythm-control background therapy, an investigational injectable was effective rapidly for most patients, investigators reported here.
In a pooled analysis of two phase 3 clinical trials, vernakalant (RSD1235) converted atrial fibrillation to a sinus rhythm in a median 10 minutes, and nearly all patients who converted had a persistent sinus rhythm over 24 hours, reported Ian Stiell, M.D., from the University of Ottawa, in Ontario, and colleagues.
Vernakalant is a frequency-dependent Na+ and early-activating K+ channel blocker that 'selectively prolongs the atrial refractory period without significantly altering ventricular refractoriness,' the authors said in a poster presentation at the American College of Emergency Physicians meeting.
The randomized, double-blind, placebo controlled ACT (Atrial Arrhythmia Conversion Trials) I and III studies were designed to study the efficacy and safety of vernakalant in patients using concomitant rate- or rhythm-control medications. /.../"
In a pooled analysis of two phase 3 clinical trials, vernakalant (RSD1235) converted atrial fibrillation to a sinus rhythm in a median 10 minutes, and nearly all patients who converted had a persistent sinus rhythm over 24 hours, reported Ian Stiell, M.D., from the University of Ottawa, in Ontario, and colleagues.
Vernakalant is a frequency-dependent Na+ and early-activating K+ channel blocker that 'selectively prolongs the atrial refractory period without significantly altering ventricular refractoriness,' the authors said in a poster presentation at the American College of Emergency Physicians meeting.
The randomized, double-blind, placebo controlled ACT (Atrial Arrhythmia Conversion Trials) I and III studies were designed to study the efficacy and safety of vernakalant in patients using concomitant rate- or rhythm-control medications. /.../"
Friday, October 13, 2006
Additional cardiovascular risk factors associated with excess weigth in children and adolescents: the Belo Horizonte heart study
Arquivos Brasileiros de Cardiologia - Additional cardiovascular risk factors associated with excess weigth in children and adolescents: the Belo Horizonte heart study:
"Robespierre Q. C. Ribeiro; Paulo A. Lotufo; Joel A. Lamounier; Reynaldo G. Oliveira; José Francisco Soares; Denise Aparecida Botter
Universidade de São Paulo e Universidade Federal de Minas Gerais - São Paulo, SP - Minas Gerais, MG
Correspondência
RESUMO
OBJETIVO: Examinar a associação de sobrepeso e obesidade com perfis de atividade física, pressão arterial (PA) e lípides séricos. MÉTODOS: Inquérito epidemiológico com 1.450 estudantes – seis a dezoito anos, em Belo Horizonte-MG. Dados: peso, altura, PA, espessura de pregas cutâneas, circunferência das cinturas, atividade física, colesterol total (CT), LDL-c, HDL-c, e hábitos alimentares. RESULTADOS:Prevalências de sobrepeso e obesidade foram 8,4% e 3,1%. Em relação aos estudantes situados no quartil inferior (Q1) da distribuição da prega subescapular, os estudantes do quartil superior (Q4) apresentaram um risco (odds ratio) 3,7 vezes maior de ter um CT aumentado. Os estudantes com sobrepeso e obesos tiveram 3,6 vezes mais risco de apresentar PA sistólica aumentada, e 2,7 vezes para PA diastólica aumentada, em relação aos estudantes com peso normal. Os estudantes menos ativos, no Q1 da distribuição de MET, apresentaram 3,8 vezes mais riscos de terem CT aumentado comparados com os mais ativos (Q4). CONCLUSÃO: Estudantes com sobrepeso ou obesos ou nos quartis superiores para outras variáveis de adiposidade, assim como os estudantes com baixos níveis de atividade física ou sedentários apresentaram níveis mais elevados de PA e perfil lipídico de risco aumentado para o desenvolvimento de aterosclerose"
"Robespierre Q. C. Ribeiro; Paulo A. Lotufo; Joel A. Lamounier; Reynaldo G. Oliveira; José Francisco Soares; Denise Aparecida Botter
Universidade de São Paulo e Universidade Federal de Minas Gerais - São Paulo, SP - Minas Gerais, MG
Correspondência
RESUMO
OBJETIVO: Examinar a associação de sobrepeso e obesidade com perfis de atividade física, pressão arterial (PA) e lípides séricos. MÉTODOS: Inquérito epidemiológico com 1.450 estudantes – seis a dezoito anos, em Belo Horizonte-MG. Dados: peso, altura, PA, espessura de pregas cutâneas, circunferência das cinturas, atividade física, colesterol total (CT), LDL-c, HDL-c, e hábitos alimentares. RESULTADOS:Prevalências de sobrepeso e obesidade foram 8,4% e 3,1%. Em relação aos estudantes situados no quartil inferior (Q1) da distribuição da prega subescapular, os estudantes do quartil superior (Q4) apresentaram um risco (odds ratio) 3,7 vezes maior de ter um CT aumentado. Os estudantes com sobrepeso e obesos tiveram 3,6 vezes mais risco de apresentar PA sistólica aumentada, e 2,7 vezes para PA diastólica aumentada, em relação aos estudantes com peso normal. Os estudantes menos ativos, no Q1 da distribuição de MET, apresentaram 3,8 vezes mais riscos de terem CT aumentado comparados com os mais ativos (Q4). CONCLUSÃO: Estudantes com sobrepeso ou obesos ou nos quartis superiores para outras variáveis de adiposidade, assim como os estudantes com baixos níveis de atividade física ou sedentários apresentaram níveis mais elevados de PA e perfil lipídico de risco aumentado para o desenvolvimento de aterosclerose"
Wednesday, October 11, 2006
Walnuts may be heart-healthy nuts
Teaching Brief® - MedPage Today: "
MedPage Today Action Points
Explain to interested patients that walnuts contain alpha-linoleic acid (a plant-based omega-3 fatty acid) and other "cardioprotective constituents" such as L-arginine and antioxidants.
Caution patients that the study looked at the effect of walnuts or olive oil added to a fatty meal in individuals on an otherwise healthy Mediterranean diet, rather than the effect on individuals who repeatedly ate high fat content meals, and did not deal with weight gain.
Review
BARCELONA, Spain, Oct. 10 -- Walnuts may be heart-healthy nuts, suggest Spanish researchers.
While both raw walnuts and olive oil decreased the sudden onset of arterial inflammation and oxidation after an unhealthy meal, the walnuts were better at keeping arteries flexible, they found.
But patients should not take this as an excuse to regularly eat fat-filled meals, followed by a handful of walnuts, said Emilio Ros, M.D., Ph.D., of the Lipid Clinic at Hospital Clínico here, and colleagues, in the Oct. 17 Journal of the American College of Cardiology.
The study, they pointed out, was small, and it looked at the effect of a single meal on individuals whose regular fare was a healthy Mediterranean diet.
Yet study participants had better arterial elasticity after a walnut-containing meal than an olive oil-containing meal. For those with moderately high cholesterol, postprandial flow-mediated dilation of the brachial artery was:
Improved by 24% when they ate walnuts with their high-fat meal (4.1% dilation before meal to 5.1% after), but
Impaired by 36% when they ate olive oil with the meal instead (3.6% dilation before meal to 2.3% after).
For individuals with normal cholesterol levels, the postprandial flow-mediated dilation was:
Unchanged in participants with normal cholesterol levels when they ate walnuts with the meal (4.2% dilation before meal to 4.2% after),
But impaired by 17% after they ate the olive oil-containing meal (4.7% dilation before meal to 3.9% after). /.../"
MedPage Today Action Points
Explain to interested patients that walnuts contain alpha-linoleic acid (a plant-based omega-3 fatty acid) and other "cardioprotective constituents" such as L-arginine and antioxidants.
Caution patients that the study looked at the effect of walnuts or olive oil added to a fatty meal in individuals on an otherwise healthy Mediterranean diet, rather than the effect on individuals who repeatedly ate high fat content meals, and did not deal with weight gain.
Review
BARCELONA, Spain, Oct. 10 -- Walnuts may be heart-healthy nuts, suggest Spanish researchers.
While both raw walnuts and olive oil decreased the sudden onset of arterial inflammation and oxidation after an unhealthy meal, the walnuts were better at keeping arteries flexible, they found.
But patients should not take this as an excuse to regularly eat fat-filled meals, followed by a handful of walnuts, said Emilio Ros, M.D., Ph.D., of the Lipid Clinic at Hospital Clínico here, and colleagues, in the Oct. 17 Journal of the American College of Cardiology.
The study, they pointed out, was small, and it looked at the effect of a single meal on individuals whose regular fare was a healthy Mediterranean diet.
Yet study participants had better arterial elasticity after a walnut-containing meal than an olive oil-containing meal. For those with moderately high cholesterol, postprandial flow-mediated dilation of the brachial artery was:
Improved by 24% when they ate walnuts with their high-fat meal (4.1% dilation before meal to 5.1% after), but
Impaired by 36% when they ate olive oil with the meal instead (3.6% dilation before meal to 2.3% after).
For individuals with normal cholesterol levels, the postprandial flow-mediated dilation was:
Unchanged in participants with normal cholesterol levels when they ate walnuts with the meal (4.2% dilation before meal to 4.2% after),
But impaired by 17% after they ate the olive oil-containing meal (4.7% dilation before meal to 3.9% after). /.../"
Psoriasis Increases Risk for Myocardial Infarction
Psoriasis Increases Risk for Myocardial Infarction - CME Teaching Brief® - MedPage Today: "PHILADELPHIA, Oct. 10 -- Psoriasis appears to be an independent risk factor for myocardial infarction, especially for younger patients with severe disease, researchers reported.
Action Points:
Encourage psoriasis patients to aggressively control their modifiable cardiovascular risk factors.
Younger patients, 30 to 40 years old, with severe psoriasis had almost twice the risk of an MI compared with similar patients without psoriasis. By contrast, 60-year-old patients with severe disease had only a 36% increased MI risk, reported Joel Gelfand, M.D., of the University of Pennsylvania here, and colleagues in the Oct. 11 issue of the Journal of the American Medical Association.
These findings came from a prospective, population-based cohort study in the United Kingdom comparing 556,995 controls and 127,139 patients with mild psoriasis and 3,837 with severe disease, in which the researchers controlled for major cardiovascular risk factors. The data have been used widely in epidemiological studies. "
Action Points:
Encourage psoriasis patients to aggressively control their modifiable cardiovascular risk factors.
Younger patients, 30 to 40 years old, with severe psoriasis had almost twice the risk of an MI compared with similar patients without psoriasis. By contrast, 60-year-old patients with severe disease had only a 36% increased MI risk, reported Joel Gelfand, M.D., of the University of Pennsylvania here, and colleagues in the Oct. 11 issue of the Journal of the American Medical Association.
These findings came from a prospective, population-based cohort study in the United Kingdom comparing 556,995 controls and 127,139 patients with mild psoriasis and 3,837 with severe disease, in which the researchers controlled for major cardiovascular risk factors. The data have been used widely in epidemiological studies. "
Tuesday, October 10, 2006
eMJA: Prevention of cardiovascular disease: an evidence-based clinical aid 2004
eMJA: Prevention of cardiovascular disease: an evidence-based clinical aid 2004: "
(Referred by Marcelo Colominas)
(Referred by Marcelo Colominas
Cardiovascular disease is the leading cause of morbidity and mortality in Australia. It is therefore important that all medical practitioners are familiar with the well documented risk factors for cardiovascular disease, as well as the outcome benefits of pharmacological and other interventions.
The large and ever-increasing body of clinical evidence, the range of patient groups at risk and the plethora of recommended interventions all make it increasingly difficult for busy doctors to adopt an integrated approach to prevention of vascular events. While absolute risk calculators, such as the Framingham Heart Study Prediction Score Sheets (www.nhlbi.nih.gov/about/framingham/riskabs.htm) or the New Zealand Cardiovascular Risk Factor Calculator (www.racp.edu.au/bp/resources/EBM_cardio.pdf), enable doctors to assign overall risk, guidelines for management are usually focused on single interventions. Moreover, the continual emergence of new data on vascular risk management redefines risk categories and approaches to risk management.
Prevention of cardiovascular disease: an evidence-based clinical aid was developed by a multidisciplinary group of physicians to address this issue and was first published by the MJA in July 2003. We have revised and updated our evaluation of current best practice based on a rigorous analysis of available published evidence to March 2004, and formulated a concise and up-to-date guide for the prevention of cardiovascular disease. This consensus of opinions is summarised in this document (see Clinical aid, page F12) and provided as a single-page chart for use in clinical practice as a desktop reference.
Patients were classified as being either at high or low risk of cardiovascular events (Box 1). It is widely considered that high-risk patients are those with clinically evident vascular disease, renal disease, diabetes or other risk factors conferring an annual risk of a future event of 2%–3% or greater. Risk can be calculated using an absolute risk-factor calculator (see above).
"Wednesday, October 04, 2006
American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging
(Referred by Marcelo Colominas [mgcolominas@gigared.com])
Coronary artery disease (CAD) and other acquired and congenital cardiac diseases are major medical and socioeconomic problems. CAD affects 13.2 million Americans and was responsible for 502 189 deaths in 2001. In 2004, the direct and indirect economic impact of CAD was in excess of $120 billion, which was about one-third of the total costs attributable to cardiovascular diseases (1).
Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease, beginning with chest radiography and fluoroscopy and progressing to coronary angiography and cardiac catheterization, ultrasonography (echocardiography), and nuclear medicine. All of these modalities have a well-established role in patient care. Computed tomography (CT), with multidetector CT and electron-beam technology, and magnetic resonance (MR) imaging, with appropriately equipped imagers, now can image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and can help assess cardiac function. Thus, CT and MR imaging will have an increasing role in comprehensive cardiac imaging./.../
Coronary artery disease (CAD) and other acquired and congenital cardiac diseases are major medical and socioeconomic problems. CAD affects 13.2 million Americans and was responsible for 502 189 deaths in 2001. In 2004, the direct and indirect economic impact of CAD was in excess of $120 billion, which was about one-third of the total costs attributable to cardiovascular diseases (1).
Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease, beginning with chest radiography and fluoroscopy and progressing to coronary angiography and cardiac catheterization, ultrasonography (echocardiography), and nuclear medicine. All of these modalities have a well-established role in patient care. Computed tomography (CT), with multidetector CT and electron-beam technology, and magnetic resonance (MR) imaging, with appropriately equipped imagers, now can image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and can help assess cardiac function. Thus, CT and MR imaging will have an increasing role in comprehensive cardiac imaging./.../
Saturday, September 23, 2006
DIA MUNDIAL DO CORAÇÃO
DIA MUNDIAL DO CORAÇÃO
(Artigo enviado para o jornal ZH mas não publicado)
Como o fazem anualmente desde 1999 a Federação Mundial de Cardiologia, junto com a OMS, a UNESCO e a Organização dos Esportes para o Desenvolvimento e Paz da ONU, designaram o dia 24 de setembro neste ano como o Dia Mundial do Coração.
O tema é: “Quão Jovem está seu Coração?” com o propósito de incentivar hábitos saudáveis de vida para evitar o envelhecimento precoce do sistema cardiovascular.
Em todo o mundo as doenças crônicas – entre as quais se situam as cardiovasculares – se constituem em problema de saúde pública, cada vez mais importante na medida em que as pessoas vivem mais e o coração e o resto do sistema vascular se deterioram prematuramente. Este não é um triste privilégio de países ricos e ditos desenvolvidos. As populações mais pobres e menos desenvolvidas, em toda a parte, terminam adoecendo mais e vivendo menos. A falta de perspectiva na vida, a ignorância e a miséria fazem mal para a saúde em todos os seus aspectos e em qualquer lugar.
Recentemente através de um grupo de trabalho concluímos um estudo para avaliar o impacto econômico das Doenças Cardiovasculares em quatro países: África do Sul, Brasil, China e Índia. O componente brasileiro está situado no Instituto de Educação e Pesquisa do Hospital Moinhos de Vento.
O ano de 2004 contava com dados suficientes para efetuar os cálculos necessários. Naquele ano o Produto Interno Bruto do Brasil foi de mais de um trilhão e setecentos bilhões de Reais. E ficou em torno de 30 bilhões o impacto global estimado destas doenças, (medicamentos, hospitalizações, licenças, aposentadorias e perda de produção). Conta-se uma de cada três mortes; e só de anos de vida saudável perdidos por ano (incapacidade e morte precoce) são cerca de 5 milhões a cada ano.
Outros dois estudos, comparando as regiões do país e comparando os distritos de Porto Alegre, mostraram também nítida correlação negativa com o nível de desenvolvimento da população residente depois de corrigidos possíveis fatores de confusão. Quanto menos educada e mais pobre a população, mais mortes por doenças do coração e mais cedo.
Não basta tratar depois que os sintomas aparecem. É preciso prevenir e não são suficientes os especialistas, consultórios e hospitais. O esforço precisa ser coletivo, na família, na escola, nas empresas, no trabalho, no lazer, nos “shoppings” – onde haja espaço onde as pessoas possam se reunir em busca de melhor qualidade de vida.
Este é um problema também nosso, é mais grave entre os mais pobres, caro de tratar, impacta na produção e pode ser prevenido. Nosso Estado foi pioneiro no Brasil incorporando há 30 anos as doenças cardiovasculares e outras crônicas na agenda da saúde pública. Vamos fazer de Porto Alegre também uma cidade de corações jovens. Investir em saúde é também um investimento econômico.
(Artigo enviado para o jornal ZH mas não publicado)
Como o fazem anualmente desde 1999 a Federação Mundial de Cardiologia, junto com a OMS, a UNESCO e a Organização dos Esportes para o Desenvolvimento e Paz da ONU, designaram o dia 24 de setembro neste ano como o Dia Mundial do Coração.
O tema é: “Quão Jovem está seu Coração?” com o propósito de incentivar hábitos saudáveis de vida para evitar o envelhecimento precoce do sistema cardiovascular.
Em todo o mundo as doenças crônicas – entre as quais se situam as cardiovasculares – se constituem em problema de saúde pública, cada vez mais importante na medida em que as pessoas vivem mais e o coração e o resto do sistema vascular se deterioram prematuramente. Este não é um triste privilégio de países ricos e ditos desenvolvidos. As populações mais pobres e menos desenvolvidas, em toda a parte, terminam adoecendo mais e vivendo menos. A falta de perspectiva na vida, a ignorância e a miséria fazem mal para a saúde em todos os seus aspectos e em qualquer lugar.
Recentemente através de um grupo de trabalho concluímos um estudo para avaliar o impacto econômico das Doenças Cardiovasculares em quatro países: África do Sul, Brasil, China e Índia. O componente brasileiro está situado no Instituto de Educação e Pesquisa do Hospital Moinhos de Vento.
O ano de 2004 contava com dados suficientes para efetuar os cálculos necessários. Naquele ano o Produto Interno Bruto do Brasil foi de mais de um trilhão e setecentos bilhões de Reais. E ficou em torno de 30 bilhões o impacto global estimado destas doenças, (medicamentos, hospitalizações, licenças, aposentadorias e perda de produção). Conta-se uma de cada três mortes; e só de anos de vida saudável perdidos por ano (incapacidade e morte precoce) são cerca de 5 milhões a cada ano.
Outros dois estudos, comparando as regiões do país e comparando os distritos de Porto Alegre, mostraram também nítida correlação negativa com o nível de desenvolvimento da população residente depois de corrigidos possíveis fatores de confusão. Quanto menos educada e mais pobre a população, mais mortes por doenças do coração e mais cedo.
Não basta tratar depois que os sintomas aparecem. É preciso prevenir e não são suficientes os especialistas, consultórios e hospitais. O esforço precisa ser coletivo, na família, na escola, nas empresas, no trabalho, no lazer, nos “shoppings” – onde haja espaço onde as pessoas possam se reunir em busca de melhor qualidade de vida.
Este é um problema também nosso, é mais grave entre os mais pobres, caro de tratar, impacta na produção e pode ser prevenido. Nosso Estado foi pioneiro no Brasil incorporando há 30 anos as doenças cardiovasculares e outras crônicas na agenda da saúde pública. Vamos fazer de Porto Alegre também uma cidade de corações jovens. Investir em saúde é também um investimento econômico.
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