Search PubMed⌕ Search

Biomedical subjects

F W Verheugt

Publications and source records attributed to F W Verheugt.

At least 19 recordsLinked to original sources
PubMed2004

[Passive smoking and the risk of coronary heart disease].

Over the past 10 years it has become clear that passive smoking is correlated with an increased risk of coronary heart disease. The relative risk of 25-30% is comparable to that of lung cancer due to passive smoking. Since coronary heart disease is the most common cause of death, it is likely that passive smoking causes many more deaths from coronary heart disease than from lung cancer. For the Netherlands, yearly figures of 2,500 to 4,000 deaths from coronary heart disease due to passive smoking are estimated. In other words, of every 10 deaths from coronary heart disease due to cigarette smoke, one is caused by passive smoking. A rigorous ban on smoking is advocated, both in public places and at home.

Coronary Disease↗
PubMed2003

[Reperfusion therapy for patients with an acute myocardial infarct with ST-segment elevation: fibrinolysis versus transport to a cardiac center for primary angioplasty].

Although fibrinolytic therapy for acute myocardial infarction is widely used and can be administered prior to hospitalisation, it is only successful in restoring full early coronary patency in about 60% of patients and has a 0.5% to 1% risk of severe side effects. Primary percutaneous coronary angioplasty carried out as an alternative to fibrinolysis avoids the risk of fibrinolytic therapy and restores patency in nearly 90% of cases. Data from randomised trials of primary angioplasty versus fibrinolytic therapy in acute myocardial infarction reveal that angioplasty results in a significant reduction in mortality. Furthermore, primary angioplasty can be improved by means of a new pre-angioplasty drug therapy (so-called facilitated primary angioplasty). Transport to a cardiac centre for primary angioplasty (of which there are 14 in the Netherlands) is feasible and safe. Although the time to treatment is delayed by a further 90 minutes, it tends to save lives and prevent strokes and it also significantly reduces the incidence of reinfarction. Interestingly, the time gained to treatment with prehospital fibrinolytic therapy compared to in-hospital therapy gave an outcome similar to that found upon comparing transport and primary angioplasty. Rescue procedures (angioplasty) within 24 hours are necessary in about 30% of patients who are initially treated with lytic therapy. These results support prehospital triage for fibrinolysis or transport to a cardiac centre, where early angioplasty can be performed if clinically indicated. A trial to determine the policy of choice is at present being conducted in the Netherlands.

Angioplasty, Balloon, Coronary↗
PubMed2003

[Resuscitations in the hospital: reporting using the Utstein-style form and a study of 183 patients in the St. Radboud University Medical Center, Nijmegen, the Netherlands, between 1997-2000].

OBJECTIVE: To evaluate the completion of the Utstein-style forms after cardiopulmonary resuscitation (CPR) in the St Radboud University Medical Center, Nijmegen (UMCN), the Netherlands, and to assess the outcomes of the CPR attempts. DESIGN: Retrospective, descriptive. METHOD: All Utstein-style forms used in the UMCN during the period 1 January 1997-31 December 2000 were examined. The data were supplemented with information from medical records. Resuscitation events initiated in the hospital were included, with the exception of those in the coronary care and intensive care units. RESULTS: 222 forms were completed, 183 of which related to in-hospital resuscitations: 104 men and 79 women with a median age of 65 years: (P25-P75: 49-75). On 148 forms (81%), the patient name, patient identifier and date of collapse were all reported. The cause of collapse was noted in 131 cases (72%). Cardiac condition during CPR was recorded in 126 cases (69%). The Glasgow coma score 10 minutes after CPR was recorded in 41 cases (22%), and 24 hours after CPR in 15 cases (8%). Information regarding follow-up was provided on 27 forms (15%): in all cases this concerned unsuccessful resuscitation. However, medical records revealed that CPR was initially successful in 105 patients (57%), and that 55 patients (30%) eventually survived to discharge. CONCLUSIONS: The variables on the Utstein-style form relating to the acute phase were poorly completed, and even fewer variables were completed for later phases. CPR was successful in 57% of the patients, and 30% left the hospital alive.

Aged↗
PubMed2001

GP IIB/IIIA blockers with and without thrombolytic agent in prehospital treatment of acute myocardial infarction.

Glycoprotein IIB/IIIA receptor blockers given early to patients with ST segment elevation acute coronary syndrome improves early coronary patency, both in the absence and presence of thrombolytic therapy. Glycoprotein IIB/IIIA receptor antagonists can be given prehospitally to patients eligible for primary angioplasty and may enhance the efficacy in improving the outcome of patients undergoing primary angioplasty for acute myocardial infarction. Glycoprotein IIB/IIIA receptor blockers used as adjunct to fibrinolytic therapy have promising angiographic results. Large trials evaluating the efficacy and safety of these combinations compared to fibrinolytic therapy alone are underway.

Drug Therapy, Combination↗
PubMed2001

[Misleading advertisement of Adalat Oros].

Referring to the INSIGHT trial published in The Lancet, Bayer Netherlands states in an advertisement in Dutch medical journals that nifedipine reduces cardiovascular events by 50% in patients with hypertension and at least one additional risk factor. However, the agent studied in the INSIGHT trial did not reduce cardiovascular events in comparison to treatment with a diuretic. On the contrary, the incidence of myocardial infarction increased (fatal infarction even increased significantly), and the risk of stroke was not significantly reduced. Therefore the advertisement is misleading.

Advertising↗
PubMed2001

Oral anticoagulant therapy during and after coronary angioplasty the intensity and duration of anticoagulation are essential to reduce thrombotic complications.

BACKGROUND: In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), the addition of oral anticoagulants to aspirin significantly reduced early and late events after coronary angioplasty. However, bleeding episodes were increased. The present report studied the intensity and the duration of anticoagulation as predictors of thrombotic and bleeding events. METHODS AND RESULTS: A total of 530 patients, 34% of whom received a stent, were treated with aspirin plus coumarins. Half of the patients were randomized to angiographic follow-up. The target international normalized ratio (INR) was 2.1 to 4.8 during angioplasty and 6-month follow-up. Thrombotic events were death, myocardial infarction, target lesion revascularization, and thrombotic stroke. Bleeding complications were hemorrhagic stroke, major extracranial bleeding, and false aneurysm. "Optimal" anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. There were 17 early thrombotic events (3.2%), 7 early bleeding episodes (1.3%), and 10 false aneurysms (1.9%). The incidence rate for both early thrombotic and bleeding events was lowest in patients in the target range. A total of 61 late thrombotic events occurred (11.6%). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19 to 0.57) and was associated with a 0.21 mm (95% CI, 0.17 to 0.42) larger vessel lumen at 6 months. Late bleeding episodes (1.4%) were lowest in patients in the target range. CONCLUSIONS: Coumarins started before coronary angioplasty with a target INR of 2.1 to 4.8 led to the lowest procedural event rate, without an increase in bleeding episodes. During follow-up, optimal anticoagulation was associated with a decrease in the incidence of late events by 67% and a significant improvement in 6-month angiographic outcome.

Administration, Oral↗
PubMed2001

[Hormonal supplement therapy in women: effects on the cardiovascular system].

Coronary heart disease develops on average 10-15 years later in women than in men and is uncommon before menopause. 17 beta-estradiol has atheroprotective properties through rapid vasodilatory effects on the endothelium by stimulating nitric monoxide production and longer-term actions by modulating changes in gene expression. Cardioprotective effects of hormone replacement therapy in postmenopausal women have been suggested by observational data but not proved in randomized trials. Recent data indicate that oestrogens have regenerative effects on the vascular wall after acute injury, like a percutaneous transluminal coronary angioplasty. As endothelial reactivity declines with age, more studies are needed to investigate the benefits of hormone replacement therapy in the younger category of postmenopausal women.

Age Factors↗
PubMed2001

Influence of planned six-month follow-up angiography on late outcome after percutaneous coronary intervention: a randomized study.

OBJECTIVES: The goal of this research was to study the effect of planned angiography on late clinical outcome after percutaneous coronary intervention. BACKGROUND: It is still largely unknown whether planned follow-up angiography after coronary angioplasty influences late outcome. METHODS: Randomization assigned 527 patients to clinical follow-up alone and 531 to clinical and six-month angiographic follow-up. The effect of planned angiography on clinical outcome at one and three years after coronary angioplasty was studied. RESULTS: The two groups were well matched. At one year, more events occurred in the angiographic group than in the clinical group: 122 (23.2%) versus 88 (16.7%) (p = 0.01). While the incidence of death or myocardial infarction (MI) was similar at one year, the revascularization rate was higher in the angiographic group: 113 (21.3%) versus 67 (12.7%) (relative risk = 1.7, 95% confidence interval: 1.3 to 2.3, p = 0.0003). At three years, still more events had occurred in the angiographic group (146 [34.5%] vs. 114 [26.3%], p = 0.03). More reinterventions did not improve late survival. However, there was a nonsignificant reduction in MI (7 [1.3%] vs. 13 [2.5%], p = NS) and a significant improvement in functional class at the end of follow-up (freedom from angina 81% vs. 74%, p = 0.03). The effect of follow-up angiography on the reintervention rate was similar for stented and nonstented patients. CONCLUSIONS: Planned follow-up angiography to evaluate the late results of coronary intervention led to a 1.7 times higher reintervention rate. This effect was similar for stented and nonstented patients. More reinterventions did not improve survival but tended to reduce the incidence of MI and led to a significantly better functional class at follow-up.

Aged↗
PubMed2001

Alterations in the peripheral circulation in patients with mild heart failure.

OBJECTIVE: In patients with severe heart failure, compensatory mechanisms fail to provide adequate blood supply to the peripheral circulation, especially when the metabolic need is increased. The aim of this study was to assess alterations in the peripheral circulation in patients with mild heart failure using ultrasound Doppler. METHODS: In 19 controls and in 11 patients with mild heart failure, Doppler spectra were recorded from the carotid, the brachial and the femoral artery at rest and, from the latter two arteries, during post-occlusive reactive hyperemia. Parameters derived from these Doppler spectra were used to make comparisons between both groups. RESULTS: At rest, the duration of the acceleration of blood was shorter in controls, the acceleration was steeper in controls and the deceleration duration was longer in controls as compared to the patients. Differences in the response to reactive hyperemia were only observed in the common femoral artery. CONCLUSIONS: In patients with mild heart failure, significant alterations in the peripheral circulation were observed especially for the femoral artery. These changes are caused by the impairment of the left ventricular function and by adjustments in the compensatory mechanism of the peripheral circulation.

Adult↗
PubMed2001

Helicobacter pylori infection as a risk factor for gastrointestinal symptoms in patients using aspirin to prevent ischaemic heart disease.

BACKGROUND: Aspirin use in the secondary prevention of ischaemic heart disease may provoke gastrointestinal discomfort. OBJECTIVE: To register gastrointestinal symptoms and complications in patients with cardiovascular disease using aspirin and to relate these symptoms to infection with H. pylori. METHODS: Blood samples were obtained from 398 consecutive patients in the Coronary-Care Unit, University Hospital Nijmegen and analysed for serum antibody levels to H. pylori infection. Questionnaires were sent 2 weeks after discharge to assess gastrointestinal symptoms. RESULTS: Questionnaires were returned by 314 patients (79%). A total of 183 out of 314 patients (46%) reported gastrointestinal symptoms. Of 238 patients using 80-100 mg aspirin daily, 145 (61%) recorded gastrointestinal symptoms. Besides aspirin, the use of calcium antagonists was correlated with gastrointestinal symptoms. Of the 128 patients using calcium antagonists, 84 (66%) reported gastrointestinal symptoms. The prevalence of gastrointestinal symptoms in H. pylori-positive and -negative patients using aspirin was 48% and 52%, respectively. CONCLUSIONS: Two weeks after discharge almost 50% of the patients with cardiovascular disease experienced gastrointestinal symptoms, especially patients using aspirin or calcium antagonists. Patients seropositive for H. pylori and using aspirin or calcium antagonists did not have more gastrointestinal discomfort compared to non-infected patients.

Aspirin↗
PubMed2001

Incidence and predictors of bleeding events after fibrinolytic therapy with fibrin-specific agents: a comparison of TNK-tPA and rt-PA.

BACKGROUND: Fibrinolytic therapy increases the risk of bleeding events. TNK-tPA (tenecteplase) is a variant of rt-PA with greater fibrin specificity and reduced plasma clearance that can be given as a single bolus. We compared the incidence and predictors of bleeding events after treatment with TNK-tPA and rt-PA. METHODS AND RESULTS: In the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT)-2 trial, 16 949 patients with acute myocardial infarction were randomly assigned a single weight-adjusted bolus of TNK-tPA or a 90-min infusion of rt-PA. A total of 4.66% of patients in the TNK-tPA group experienced major non-cerebral bleeding, in comparison with 5.94% in the rt-PA group (P=0.0002). This lower rate was associated with a significant reduction in the need for blood transfusion (4.25% vs 5.49%, P=0.0003) and was consistent across subgroups. Independent risk factors for major bleeding were older age, female gender, lower body weight, enrolment in the U.S.A. and a diastolic blood pressure <70 mmHg. Females at high risk (age >75 years and body weight <67 kg) were less likely to have major bleeding when treated with TNK-tPA even after other risk factors were taken into account. A total of 0.93% of patients in the TNK-tPA and 0.94% of patients in the rt-PA group experienced an intracranial haemorrhage. Female patients >75 years of age who weighed <67 kg tended to have lower rates of intracranial haemorrhage when treated with TNK-tPA (3/264, 1.14% vs 8/265, 3.02%). CONCLUSIONS: The increased fibrin specificity and single bolus administration of TNK-tPA do not increase the risk of intracranial haemorrhage but are associated with less non-cerebral bleeding, especially amongst high-risk patients.

Adult↗