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At least 757 records · Page 42Linked to original sources
PubMed2001

Long-term effects on cholesterol levels and the utilization of lipid-lowering drugs of a hospital-based programme for secondary prevention of coronary artery disease.

BACKGROUND: The study was designed to determine whether a 1-year hospital-based secondary prevention programme would have any long-term effects on serum lipid levels and the use of lipid-lowering drugs in patients with coronary artery disease 4 years after referral to primary care facilities for follow-up. DESIGN/METHODS: After acute myocardial infarction or coronary bypass surgery, 241 consecutive patients were randomly assigned to conventional care (CC) by the primary health care facilities or to a 1-year hospital-based secondary prevention programme (SPP) with target levels for serum cholesterol (< 5.2 mmol/l) and triglycerides (< 1.5 mmol/l). After 1 year all patients were referred to the primary care sector for a further 4-year follow-up. RESULTS: At the 1-year follow-up there was a significant decrease in serum cholesterol, LDL-cholesterol and triglyceride levels in the SPP group but no change in the CC group, and lipid-lowering drugs were used more frequently in the SPP group. These changes were maintained after 5 years. The proportion of patients achieving target serum cholesterol and triglyceride levels were larger in the SPP group. CONCLUSIONS: Initiatives regarding cholesterol lowering and drug treatment taken by specialists within a structured hospital-based SPP have long-term impact. Accordingly, drug treatment should be initiated and adjusted to adequate doses before patients are referred to primary care for follow-up.

Aged↗
PubMed2001

Risk factors for mortality in primary isolated coronary artery bypass grafting surgery.

BACKGROUND AND PURPOSE: Identifying the risk factors for mortality in coronary artery bypass grafting (CABG) surgery is important to improve surgical results. The purpose of this study was to identify the risk factors for mortality in primary isolated CABG in a series of Taiwanese patients. METHODS: Medical records of 914 patients who underwent primary isolated CABG surgery in Veterans General Hospital-Taipei during the period from January 1, 1991, to December 31, 1995, were reviewed. Eighteen clinical and seven operative variables were included in the univariate and multivariate analyses to identify the determinants of mortality in CABG surgery. RESULTS: Thirty-one patients (3.4%) died within 30 days after surgery; 41 (4.5%) died during hospitalization for the procedure. After univariate and multivariate analyses, emergency surgery, history of myocardial infarction, concomitant peripheral artery occlusive disease (PAOD), and prolonged cardiopulmonary bypass (CPB) were found to be significant determinants of mortality in primary isolated CABG. Other variables, including age, sex, angina class, NYHA class, diabetes mellitus, the number of anastomoses, aortic cross-clamp time, stenosis of the left main coronary artery, the number of stenotic coronary arteries, history of congestive heart failure, and a left ventricular ejection fraction less than 35%, were not significant determinants of mortality. Patients undergoing emergency surgery were found to be at highest risk of mortality. CONCLUSIONS: Patients undergoing emergency surgery who had a history of myocardial infarction, concomitant PAOD, or prolonged CPB were at higher risk of mortality in CABG surgery. More comprehensive techniques in myocardial protection, surgical procedures, and postoperative care should be used in the treatment of high-risk patients to reduce mortality.

Aged↗
PubMed1999

Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group.

BACKGROUND: Although it is generally accepted that lowering elevated serum levels of low-density lipoprotein (LDL) cholesterol in patients with coronary heart disease is beneficial, there are few data to guide decisions about therapy for patients whose primary lipid abnormality is a low level of high-density lipoprotein (HDL) cholesterol. METHODS: We conducted a double-blind trial comparing gemfibrozil (1200 mg per day) with placebo in 2531 men with coronary heart disease, an HDL cholesterol level of 40 mg per deciliter (1.0 mmol per liter) or less, and an LDL cholesterol level of 140 mg per deciliter (3.6 mmol per liter) or less. The primary study outcome was nonfatal myocardial infarction or death from coronary causes. RESULTS: The median follow-up was 5.1 years. At one year, the mean HDL cholesterol level was 6 percent higher, the mean triglyceride level was 31 percent lower, and the mean total cholesterol level was 4 percent lower in the gemfibrozil group than in the placebo group. LDL cholesterol levels did not differ significantly between the groups. A primary event occurred in 275 of the 1267 patients assigned to placebo (21.7 percent) and in 219 of the 1264 patients assigned to gemfibrozil (17.3 percent). The overall reduction in the risk of an event was 4.4 percentage points, and the reduction in relative risk was 22 percent (95 percent confidence interval, 7 to 35 percent; P=0.006). We observed a 24 percent reduction in the combined outcome of death from coronary heart disease, nonfatal myocardial infarction, and stroke (P< 0.001). There were no significant differences in the rates of coronary revascularization, hospitalization for unstable angina, death from any cause, and cancer. CONCLUSIONS: Gemfibrozil therapy resulted in a significant reduction in the risk of major cardiovascular events in patients with coronary disease whose primary lipid abnormality was a low HDL cholesterol level. The findings suggest that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels.

Aged↗
PubMed2006

Mechanical reperfusion during acute myocardial infarction in a patient with dextrocardia.

Mechanical reperfusion is the preferred treatment for acute ST-elevation myocardial infarction, we describe a case of successful primary angioplasty and stenting in a patient with dextrocardia and situs inversus. Dextrocardia with complete situs inversus is a rare condition, occurring in about 2 in 10,000 live births. However, ischemic heart disease and myocardial infarction have been reported in patients with dextrocardia, and hence the coexistence of myocardial infarction and dextrocardia is not unusual. The incidence of atherosclerosis in this group is not known, but is considered to be the same as that in the general population. There have been a few reports of percutaneous coronary intervention in these patients. We describe a case of primary angioplasty and stenting in a patient with dextrocardia and situs inversus and the electrocardiographic correlation of successful myocardial reperfusion.

Angioplasty, Balloon, Coronary↗
PubMed1998

Successful coronary stent implantation in a patient with primary antiphospholipid syndrome.

We report a 22-year-old man who successfully underwent coronary stent implantation after an acute myocardial infarction. Lupus anticoagulant and antibodies against cardiolipin and prothrombin were detected despite the absence of any underlying disease. Therefore, long-term oral anticoagulation was instituted and appeared to be effective. To our knowledge this is the first report on coronary stenting in primary antiphospholipid syndrome.

Adult↗
PubMed1993

Design and baseline results of the Scandinavian Simvastatin Survival Study of patients with stable angina and/or previous myocardial infarction.

The Scandinavian Simvastatin Survival Study is a clinical trial of patients with coronary artery disease (CAD) and mild or moderate hypercholesterolemia. The primary objective is to investigate whether long-term treatment with the serum lipid-lowering agent simvastatin in patients with serum total cholesterol levels between 5.5 and 8.0 mmol/liter (212 to 309 mg/dl) will reduce overall mortality. The secondary objective is to investigate whether simvastatin treatment reduces the incidence of major CAD events (fatal and nonfatal myocardial infarction and sudden death). This is a multicenter, randomized, double-blind, placebo-controlled clinical trial. Patients of both sexes, aged 35 to 69 years, with stable angina pectoris or previous myocardial infarction were recruited at 94 clinical centers throughout Scandinavia. Dietary advice was given to 7,027 patients who were followed for 2 months. Of these, 4,444 met the eligibility criteria and were subsequently randomized to receive simvastatin or similar placebo tablets. The patients will be followed for a minimum of 3 years and until total mortality reaches 440 deaths. This report presents certain design features of this study such as methods of recruitment and follow-up of patients, adjustment procedures for the test drug dose, sample size and power calculations, and organization of the study. Baseline results are summarized and ethical aspects of the study are also discussed.

Adult↗
PubMed1986

[Acute myocarditis in Lyme's syndrome. Value of myocardial scintigraphy with gallium 67].

The authors report the case of a 35 year old man with no known previous cardiac disease. One month after a tic bite causing diffuse abdominal erythema, he was admitted to hospital with fever, breathlessness and bradycardia. The electrocardiogramme showed first degree atrioventricular block with a sinoatrial block (SA = 200 ms, AH = 240 ms). Echocardiography eliminated the diagnosis of pericardial effusion. Thallium 201 myocardial scintigraphy was pathological and showed irregular global uptake suggesting cardiomyopathy. Gallium 67 scintigraphy showed increased uptake in the left ventricle. The evolution was uncomplicated with normalisation of clinical, ECG and radiological changes. Cardiac catheterisation and angiography eliminated ischaemic and primary cardiomyopathy. Control radionuclide investigations were normal at one month: there was no persistent abnormal Gallium uptake. The diagnosis of Lyme's syndrome was confirmed by positive serology with successive titres of 1/1024 and 1/2048 (significant at titres over 1/256). This unusual case illustrates: the risk of myocardial disease in Lyme's syndrome; the diagnostic value of Gallium 67 scintigraphy in acute myocarditis: Gallium seems to fix specifically on inflamed tissues, so distinguishing myocarditis from primary cardiomyopathies.

Acute Disease↗
PubMed1980

[Organization of the control of the cardiovascular diseases in the Lithuanian SSR].

Experience in elaborating and introducing into medical practice the elements of a unified consecutive system of ischemic heart disease control was developed in Kaunas. This system includes epidemiological detection of risk factors, primary prevention, and rehabilitation of patients with myocardial infarction and their subsequent regular medical surveillance. According to the system, the methods of primary and secondard prevention, diagnosis, treatment and rehabilitation are unified and standardized and a unified system of the registration and hospitalization of cardiological patients is introduced in Kaunas. Mathematical processing of the data was carried out by a computer. Methodical material has been elaborated and suggested for practical medicine.

Adult↗
PubMed1987

Follow up results of treatment of unstable angina by coronary angioplasty.

Eighty nine of 327 consecutive patients undergoing coronary angioplasty at a centre had unstable angina--defined as either a worsening of the frequency or the severity of chest pain or severe episodes of chest pain at rest with no evidence of acute myocardial infarction. Multivessel disease was present in 31 of these patients. Two or more vessels were dilated in the same procedure in one fifth of the patients. Primary success was obtained in 80 (90%) patients. Acute myocardial infarction was a complication in four (5%) patients, including two of four patients who needed emergency coronary bypass grafting. Follow up coronary angiography at a mean (SD) of 10 (6) months in 57 patients showed restenosis in 21 (37%): of these, 13 patients had repeat coronary angioplasty and three had elective coronary bypass grafting. All patients in whom angioplasty was initially successful were followed up for 10 (6) months after the last angioplasty procedure. There were no deaths. One patient had sustained a myocardial infarction unrelated to the dilated vessel. Clinically, 74 patients improved by at least one New York Heart Association class and 40 (50%) were symptom free and with no signs or symptoms of myocardial ischaemia on a stress test. Coronary angioplasty offers long term symptomatic improvement at an acceptable risk in the majority of patients with unstable angina.

Adult↗
PubMed2006

[Lowering cholesterol in the elderly--yes, no, or maybe?].

At the present time, there is no adequate database for the application of statins for cholesterol lowering in geriatric patients. According to the current position adopted by the IOWiG (Institut für Qualität and Wirtschaftlichkeit im Gesundheitswesen = institute for quality and economy in health care), the usefulness of statins in patients with stable CAD or acute coronary syndrome can be affirmed. The National Institute of Clinical Excellence favors the administration of statins both in primary and secondary prevention of CAD and myocardial infarction, and also as a secondary prevention measure in non-severe stroke, PAD, unstable angina pectoris, and following revascularization procedures on the coronary arteries. Evidence for the superiority of the statins in patients older than 75 is, to date, available only for the indication of CAD in patients with elevated LDL cholesterol, but only up to the age of 80 years. Secondary prevention with statins leading to multipharmacotherapy must be rejected on account of the incalculable risk of side effects and drug interactions.

Age Factors↗
PubMed2003

The right heart in congenital heart disease.

The clinical presentation of right ventricular (RV) dysfunction due to congenital heart disease (CHD) is similar to that of cor pulmonale. RV volume and pressure loads, and primary RV myocardial dysfunction are mechanisms by which CHD affects right heart function. RV volume load may arise from pre-tricuspid left to right shunts (e.g., atrial septal defect) or regurgitant lesions in the right heart (e.g., Ebstein's anomaly of the tricuspid valve and pulmonary insufficiency after repair of tetralogy of Fallot). RV pressure load may be caused by anatomic obstruction to RV outflow and by pulmonary arteriolar hypertension. The latter can result from Eisenmenger syndrome secondary to congenital and postoperative left to right shunts or from defects that cause pulmonary venous hypertension (e.g., pulmonary vein stenosis, cor triatriatum, or mitral stenosis). The RV myocardium may be affected by a primary cardiomyopathy or by congenital abnormalities of the coronary vessels. Finally, CHD may be associated with airway obstruction, scoliosis, or pulmonary emboli, which, in turn, may lead to the development of cor pulmonale. Congenital heart disease, therefore, must be included in the differential diagnosis of patients who present with right ventricular dysfunction.

Journal Article↗
PubMed2000

Antiplatelet drugs in cardiovascular prevention: coronary events and stroke: primary prevention.

(1) Aspirin reduces the risk of myocardial infarction in men over 40 with no history of cardiovascular disease, and in hypertensive patients of both sexes over that age. But it does not seem to reduce overall mortality, and its risk-benefit ratio is not very favourable because of its gastrointestinal adverse effects. (2) In patients with symptomatic lower-limb arterial disease, ticlopidine and clopidogrel reduce the risk of coronary events.

Aspirin↗
PubMed1996

The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease.

BACKGROUND: Transdermal nicotine therapy is widely used to aid smoking cessation, but there is uncertainty about its safety in patients with cardiac disease. METHODS: In a randomized, double-blind, placebo-controlled trial at 10 Veterans Affairs medical centers, we randomly assigned 584 outpatients (of whom 576 were men) with at least one diagnosis of cardiovascular disease to a 10-week course of transdermal nicotine or placebo as an aid to smoking cessation. The subjects were monitored for a total of 14 weeks for the primary end points of the study (death, myocardial infarction, cardiac arrest, and admission to the hospital due to increased severity of angina, arrhythmia, or congestive heart failure); the secondary end points (admission to the hospital for other reasons and outpatient visits necessitated by increased severity of heart disease); any side effects of therapy; and abstinence from smoking. RESULTS: There were 48 primary and 78 secondary end points noted in a total of 95 subjects. At least one of the primary end points was reached by 5.4 percent of the subjects in the nicotine group and 7.9 percent of the subjects in the placebo group (difference, 2.5 percent; 95 percent confidence interval, -1.6 to 6.5 percent; P=0.23). In the nicotine group, 11.9 percent of the subjects had at least one of the secondary end points, as compared with 9.7 percent in the placebo group (difference, 2.2 percent; 95 percent confidence interval, -2.2 to 7.4 percent; P= 0.37). After 14 weeks the rate of abstinence from smoking was 21 percent in the nicotine group, as compared with 9 percent in the placebo group (P=0.001), but after 24 weeks the abstinence rates were not significantly different (14 percent vs. 11 percent, P= 0.67). CONCLUSIONS: Transdermal nicotine does not cause a significant increase in cardiovascular events in high-risk outpatients with cardiac disease. However, the efficacy of transdermal nicotine as an aid to smoking cessation in such patients is limited and may not be sustained over time.

Administration, Cutaneous↗
PubMed1988

The low plasma testosterone levels of young Indian infarct survivors are not due to a primary testicular defect.

A case control study was performed to determine whether the hypotestosteronaemia described in men with coronary artery disease could be the result of primary testicular dysfunction. Testicular function was assessed by comparing the response of 10 young Indian men with myocardial infarction to human chorionic gonadotrophin (HCG) injection to that of 10 healthy age and weight matched controls. The basal testosterone levels in the patients were significantly lower (12.71 +/- 1.36 nmol/l vs 16.51 +/- 0.79 nmol/l; P = 0.01) and the basal oestradiol levels significantly higher than the controls (120.67 +/- 8.81 pmol/l vs 94.05 +/- 8.23 pmol/l; P = 0.02). There was no difference in the sex hormone binding globulin concentrations. However, following HCG stimulation the patients demonstrated a normal response with a 2-fold increase in testosterone. There was no difference in the testosterone and oestradiol levels of the patients and controls following HCG stimulation. This normal response in our patients demonstrates that the hypotestosteronaemia in Indian men with myocardial infarction is not due to a primary testicular dysfunction but probably is a result of increased aromatization of testosterone to oestradiol.

Adult↗
PubMedDate not supplied

Immediate and follow-up results of coronary angioplasty--lessons for the future.

In a series of 129 patients having coronary angioplasties in St. James's Hospital in 1989, the average age was 54.8 (30-77 years). There were 102 (79%) men and 27 (21%) females. Clinical indications were unstable angina 62, stable angina 26, post myocardial infarction 39 and asymptomatic ischaemia 2. The distribution of coronary disease was single vessel 62%, double vessel 28%, triple vessel 7% and previous coronary bypass surgery 3%. Only 10 patients had more than one vessel dilated. Primary success was achieved in 119 (92%), there were no deaths, 3 patients had abrupt closure of the vessel during angioplasty and sustained a nonfatal myocardial infarction, 1 patient required urgent bypass surgery and 2 patients had peripheral vascular complications requiring surgery. There were 6 failed angioplasties, 4 of which had chronic total occlusion. At a mean follow-up of 5.3 months, 85 patients had no symptoms, 34 had angina, 2 developed myocardial infarction and 1 died suddenly at 5 months. Repeat angiography was performed in 96 (79%) patients. At follow-up, no symptoms were present in 69% of those with single vessel disease and 70% of multivessel disease. Of those who had more than one vessel dilated in multivessel disease, 80% were asymptomatic (P = NS). There were 11 patients with initial total occlusion at presentation, 4 had failed angioplasties, 5 recurrent angina of which 4 reoccluded and 1 restenosed and only 2 were asymptomatic and without restenosis. Angioplasty was performed with primary success (92%) and follow up results (70% asymptomatic). Those with single or multivessel disease had similar clinical outcome, favouring the use of target vessel angioplasty. Long term results following angioplasty of chronic total occlusions were poor and suggests the need for additional treatment.

Angioplasty, Balloon, Coronary↗
PubMed1988

Long term warfarin treatment in artery disease.

The long-term use of oral anticoagulants like warfarin in artery disease has long been controversial. Possible aims of treatment include the primary or secondary prevention of systemic embolism, preventing recurrence after myocardial infarction or the progression of transient cerebral ischemia to a complete stroke, and the prevention of artery graft occlusion. The value of long-term anticoagulation is generally accepted in the few situations where, as in patients with mechanical heart valve prostheses, mitral valve disease and atrial fibrillation, or idiopathic dilated cardiomyopathy, the risk of arterial thromboembolism without anticoagulation is known to be high and there is good evidence that anticoagulants are effective, so the benefit:risk balance strongly favours their use. In many settings, however, it is hard to justify long-term warfarin treatment as the benefit:risk balance remains unknown; either because the risk of thromboembolism without anticoagulation remains to be clearly defined (as in the case of patients with 'lone' atrial fibrillation), or because possible benefits have not been well documented (as after transient cerebral ischemia or peripheral vascular surgery). Finally, there is the difficult problem of estimating the benefit from long-term anticoagulation after myocardial infarction. It seems that warfarin can reduce the likelihood of non-fatal reinfarction with relative safety in highly selected patients, but whether it reduces mortality, and how its effect compares with that of other, more recent, therapies aimed at preventing reinfarction, remains unknown.

Cerebrovascular Disorders↗
PubMed2003

An unusual cause of new-onset atrial flutter: primary cardiac lymphoma.

Primary cardiac lymphoma is a rare disease with a high mortality rate due to the advanced stage of myocardial involvement at presentation. The diagnosis is extremely difficult to make because of the rarity of the disease, variability of clinical manifestations, limited noninvasive diagnostic techniques available, and difficulties and/or delays in the use of invasive measures. The incidence of the disease is increasing, especially among immunocompromised patients, with those suffering from acquired immunodeficiency syndrome accounting for the greatest increase. We report the case of an immunocompetent 76-year-old black woman who presented with near-syncopal episodes. Transthoracic echocardiogram revealed a right atrial mass. Surgical resection was performed, and a diagnosis of large B-cell non-Hodgkin's lymphoma was made. Primary cardiac lymphoma should be considered in any patient with a cardiac mass. Prompt diagnosis and treatment of primary cardiac lymphoma is imperative for survival.

Aged↗