How safe are very low LDL cholesterol levels?
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Journal Article↗
Biomedical subjects
Sarkis B Baghdasarian
Publications and source records attributed to Sarkis B Baghdasarian.
The role of myocardial perfusion imaging in the diagnosis of patients with coronary artery disease: developments over the past year.
PURPOSE OF REVIEW: The role of myocardial perfusion imaging in the diagnosis of coronary artery disease in various patient populations has been expanding. Recent literature from March 2004 to February 2005 has advanced the concept of attenuation correction and electrocardiographic gating in improving the diagnosis of coronary artery disease. RECENT DEVELOPMENTS: The American Heart Association encourages the use of electrocardiographic-gated single photon emission computerized tomography in women. Asymptomatic diabetic patients may benefit from screening with myocardial perfusion imaging. Dobutamine stress perfusion imaging is an important diagnostic tool in elderly patients who are unable to exercise. In patients with chest pain, acute imaging may decrease unnecessary admissions. Vasodilator stress imaging has high sensitivity and specificity in patients with left bundle branch block. Patients undergoing endovascular stent grafting may benefit from risk stratification with vasodilator myocardial perfusion imaging. The American Society of Nuclear Cardiology and the Society of Nuclear Medicine have recognized the role of attenuation correction in increasing the diagnostic accuracy of myocardial perfusion imaging. Multiple studies emphasize the importance of electrocardiographic gating in myocardial perfusion imaging. SUMMARY: Recent developments have resulted in an important statement by the American Heart Association that assigns a larger role for myocardial perfusion imaging in the diagnosis of coronary artery disease in women. The role of myocardial perfusion imaging is also expanding in various other patient populations. The literature has validated the concept of attenuation correction for the accurate assessment of attenuation artifacts as well as electrocardiographic gating in enhancing the diagnosis and risk stratification for coronary artery disease.
Coronary Artery Disease↗
Association of dyslipidemia and effects of statins on nonmacrovascular diseases.
BACKGROUND: Statins have mechanisms of action that expand their effects beyond cholesterol lowering and atherosclerotic medical conditions. OBJECTIVE: This review summarizes clinical evidence for the association of dyslipidemia and the effects of statin use on aortic stenosis, Alzheimer's dementia (AD), osteoporosis, prevention of diabetes mellitus (DM), diabetic retinopathy, age-related macular degeneration, and diabetic/nondiabetic nephropathy. METHODS: An English-language literature search was conducted using MEDLINE (1966-June 2003). Bibliographies of retrieved articles were reviewed. Search terms included statin, HMG-CoA reductase inhibitors, aortic stenosis, Alzheimer's dementia, osteoporosis, prevention of diabetis, diabetic retinopathy, age-related macular degeneration, diabetic nephropathy, and nondiabetic nephropathy. RESULTS: Three retrospective cohort trials have shown an association between statin use and the progression of aortic stenosis; one of these trials observed a 45% decrease in aortic valve area in 1 year. In AD, one cross-sectional analysis found 60% to 73% lower AD rates in lovastatin or pravastatin recipients ( P<0.001 ). Of the multiple observational studies on the effect of statins on fracture risk, some have shown a decreased risk, with an odds ratio as low as 0.50 (95% CI, 0.33-0.76); others have demonstrated no association. A post hoc analysis of the West of Scotland Coronary Prevention Study found a 30% reduction in the development of DM ( P=0.042 ), but this was not duplicated in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm. A small clinical trial of 6 patients (11 eyes) demonstrated improved retinal hard exudates with pravastatin treatment in patients with diabetic retinopathy. In a cross-sectional analysis, age-related macular degeneration was found to be less common among statin users than nonusers (4% [ 1/27 ] vs 22% [ 76/352 ]; P=0.02. Multiple small clinical trials of 19 to 56 patients with diabetic and nondiabetic nephropathy at various stages generated inconsistent results for an association between statin use and decreased albumin excretion rate and decreased rate of decline in glomerular filtration. CONCLUSION: Data of variable quantity and quality support the use of statins as adjuncts in the treatment of nonmacrovascular diseases.
Alzheimer Disease↗
Evaluation and interventions to reduce errors in HIV-2 testing.
When patients are evaluated for human immunodeficiency virus (HIV) infection, the possibility of HIV type 2 (HIV-2) infection should be considered in individuals who may have acquired infection in West Africa or from an individual from that area. A 45.6% error rate in HIV-2 test ordering was observed among patients at the Cleveland Clinic Foundation, this was attributed in large part to the order entry screen, which may have confused ward clerks who were entering HIV testing ordered by clinicians. Modification of the order entry screen and consultation with clinical laboratory personnel for diagnostic HIV-2 testing were effective in reducing the rate of errors tenfold, to 4.3%.
AIDS Serodiagnosis↗