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At least 1,153 records · Page 64Linked to original sources
PubMed1999

[Lipid-lowering therapy in patients with coronary disease: proportion of patients requiring treatment according to recommendations of the Swiss Society of Cardiology].

BACKGROUND: Recent studies have confirmed that treatment with lipid-lowering drugs decreases cardiovascular morbidity and mortality in primary as well as secondary prevention of cardiovascular diseases. In 1999, new Swiss recommendations for treatment with lipid-lowering drugs have been published. We therefore performed a study to estimate the proportion of patients with coronary artery disease requiring lipid-lowering drugs. METHODS: We included 637 patients with coronary heart disease who were referred for coronary angiography during 1991-1993. We calculated the proportion of patients requiring lipid-lowering drugs according to the new Swiss guidelines, and compared them with European and US guidelines. RESULTS: According to the 1999 Swiss recommendations, 79% of the study population would have qualified for lipid-lowering treatment (males 80%, females 78%; patients aged up to 69 years 80%, patients aged 70 years and over 73%). Agreement with both the Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention, and the ACC/AHA Guidelines for Management of Patients with Acute Myocardial Infarction, was 96% (Kappa 0.79 and 0.83 respectively). CONCLUSION: A large proportion of patients with coronary artery disease qualifies for treatment with lipid-lowering drugs. The new Swiss recommendations closely agree with European and US guidelines.

Aged↗
PubMed1980

Coronary disease and anaesthesia.

The anaesthetic care of patients with coronary artery disease can probably be improved. The goal is to maintain a favourable myocardial oxygen supply/demand ratio. This may necessitate the use of beta-blockade and vasodilators, or alternatively perhaps halothane, in order to reduce arterial pressure and heart rate, and thereby reduce myocardial work. Normoventilation and adequate analgesia help to prevent increases in peripheral resistance. Careful ECG monitoring may reveal ischaemia or left ventricular strain, which should be regarded as an indication to reduce myocardial work.

Anesthesia↗
PubMed1978

Effect of sublingual nitroglycerin on regional flow in patients with and without coronary disease.

We evaluated the effects of sublingual nitroglycerin on indices of regional coronary flow and coronary resistance (CR) in 12 selected patients with coronary artery disease (CAD) and eight with normal coronary arteries (NCA), using continuous thermodilution. Resting total left ventricular flow, reflected by coronary sinus flow (CSF), and anterior regional flow, reflected by great cardiac vein flow (GCVF), in NCA and CAD patient groups, were similar. However, in a subgroup of six patients, with CAD limited to the anterior descending artery, GCVF was lower and anterior regional CR (CRANT) higher than the NCA subjects. Nitroglycerin reduced the systolic pressure-heart rate product similarly in both patient groups. CSF and GCVF in NCA subjects declined 15% and 17%, respectively, as total CR (CRT) and CRANT increased. In the CAD subgroup, consisting of patients with CAD limited to the anterior descending, GCVF increased 48% as CRANT declined 50%, and CSF was unchanged. In the other CAD subgroup of patients with CAD in the right and/or circumflex arteries, GCVF declined 32% and CRANT increased 46% as CSF was minimally increased. These data imply that sublingual nitroglycerin reduces both CSF and GCVF in NCA patients as oxygen demands decrease. In certain CAD patients, however, nitroglycerin alters regional coronary venous blood flow, suggesting a redistribution of flow from normally perfused to hypoperfused regions.

Administration, Oral↗
PubMed1994

[Quantification of myocardial tomography with thallium in coronary disease. Evaluation of the Cedars-Sinai technique].

OBJECTIVE: The aim of this study is to evaluate the contribution of the Cedars-Sinai quantification tomographic method (CS) in the diagnosis and localization of ischemic areas in coronary artery disease (CAD) and to optimize the threshold values proposed by CS. PATIENTS AND METHODS: Fifty patients with clinical suspicion of CAD performed a maximal stress test by cycloergometer; thallium myocardial tomographic images were obtained; applying the CS program afterwards. The sensitivity and specificity variations obtained by changing the criteria for extent of myocardial hypoperfusion (range 1% to 100%) were used to calculate the new thresholds (CS-I), using the results of coronariographic studies as a reference. The data determined by qualitative analysis were compared with that obtained by quantitative analysis by means of CS and CS-I using coronary angiography as the standard of reference. RESULTS: The coronary angiography showed coronary disease in 37 patients. The sensitivity for the diagnosis of CAD was superior using CS (97%) at the expense of low specificity (15%) which nevertheless improved with CS-I (54%). For the location of CAD, the visual analysis was statistically significant (p < 0.05) in the left anterior descending and right coronary arteries, CS being superior in the diagnosis of 3 vessel disease. CONCLUSIONS: The quantification of tomographic studies with thallium by means of CS needs a readjustment of the thresholds. The tested values (CS-I) improved the CS results, although they require prospective validation. Quantitative study permits the confirmation of visual findings, being a complementary method that can be rapidly and easily interpreted, although it is not recommended as a single technique for the diagnosis of coronary disease.

Adult↗
PubMed2005

[Abnormal gastrointestinal findings in patients with coronary disease revealed by endoscopy before cardiac surgery].

OBJECTIVES: To assess incidence of different abnormal gastrointestinal changes revealed by endoscopy before cardiac surgery in different female and male age groups and to establish criteria for carrying out preventive endoscopy in patients with coronary disease. MATERIAL AND METHODS: Retrospective analysis was performed on 3847 patients (63.2% and 36.8% of male and female patients, respectively; mean age 61.9+/-11.9) who underwent fiberoptic esophagogastroduodenoscopy (FEGDS) before cardiac surgery under extracorporeal circulation at Kaunas University of Medicine Hospital in 2000-2003. Study population was divided into two groups: group I consisted of 2348 (61%) patients whose endoscopy revealed active bleeding from mucous membranes of gastrointestinal tract (bleeding gastric or duodenal ulcer) or any other abnormal findings indicating bleeding potential (gastric and duodenal erosion or ulcer); group II comprised 1499 (39%) patients whose endoscopy revealed no abnormal changes or the revealed ones (scars, hiatal hernia, etc.) that cannot cause bleeding. RESULTS: No statistically significant differences were established in male and female percentage both generally and individually in groups (63.2% and 36.8% in all population studied; 61% and 39%, 64.6% and 35.4% in group I and group II, respectively). Further data analysis showed that FEGDS revealed changes requiring pre-surgical treatment in even 62.4% of male patients; meanwhile the similar changes were diagnosed in 58.7% of female patients. Incidence analysis of abnormal changes in terms of patient age established that even 31.1% of the group I population were patients aged 61-70, and 26.5%--patients aged 51-60. It should also be noted that these age groups were represented in the most ample manner in all population studied--31.7% (1209 patients) and 26.5% (1012 patients), respectively. The highest incidence of bleeding potential changes in male patients was found in the 51-60 year-old group (30.7% (462 patients)) and 61-70 year-old group (29% (436 patients)); in female patients, the highest incidence was observed in the 61-70 year-old group (35.2% (290 patients)) and 71-80 year-old group (25.6% (211 patients) (p<0.05). Data analysis showed that just 20.1% and 10.9% of male and female patients respectively were diagnosed with the changes mentioned in the age groups of up to 50 year-old. The study established that only 14.5% of FEGDS carried out revealed no abnormal changes in the upper gastrointestinal tract. CONCLUSION: Abnormal gastrointestinal changes indicating bleeding potential were established with significantly higher incidence in male compared with female patients. Gastrointestinal endoscopy before cardiac surgery under extracorporeal circulation should be carried out in 50-70 year-old male patients and 60-80 year-old female patients, while carrying out of the same examination in the younger and older patients is subject to additional indications. Only 14.5% of fiberoptic esophagogastroduodenoscopies carried out revealed no abnormal changes in the upper gastrointestinal tract.

Age Factors↗
PubMed1981

Effect of platelet suppressant treatment with dipyridamole and aspirin on exercise performance and platelet survival time in coronary disease.

Platelets may contribute to the pathogenesis of atherosclerotic coronary artery disease (CAD), and platelet reactivity may be activated by exercise. Fourteen men with CAD participated in a double-blind, crossover study of aspirin (ASA), dipyridamole (DPY), ASA-DPY, and placebo. The ASA therapy increased platelet survival time (autologous labelling with 51Cr), but had no effect on either the duration of angina-limited treadmill exercise or the heart rate-systolic blood pressure product (x 10(-2)) at peak exercise. The combination DPY-ASA had a greater effect on platelet survival, but did not substantially increase the duration of exercise. Administration of DPY alone at a higher dosage increased the exercise duration and had a similar effect on platelet survival. At the time that control exercise was completed with the higher dosage of DPY, the rate-pressure product was decreased. The results suggest that DPY and ASA favorably alter the platelet survival in men with CAD, and that DPY, but not ASA, favorably alters exercise performance. Although ASA and ASA-DPY may alter platelet response to exercise, the effect is not shown in hemodynamic measurements during exercise. In higher dosages, DPY may be an effective coronary vasodilator for men with CAD.

Aspirin↗
PubMed1994

[Exercise training and rehabilitation techniques in patients with coronary disease].

Exercise rehabilitation is widely prescribed for patients with coronary artery disease and requires the same rigorous approach as physical training in athletes. Training techniques have been carefully described, but the precise physiological justification remains to be elucidated. In order to target the physiological mechanisms which rehabilitation training is designed to improve, it is necessary to have a coherent strategy and apply the techniques with a clear idea of the objective to be attained. We describe the programme we propose to our patients. First, patients are advised to fraction their exercise into short relatively intense periods of exertion separated by rest periods as long as the exertion period. This method is designed to develop the "power" of the aerobic energy system. Later, we progressively introduce longer periods of training at moderate intensity. This part of the rehabilitation is designed to develop the "capacity" of the aerobic system. The decision to develop work capacity is based on the patient's response to the first part of the rehabilitation programme.

Aerobiosis↗
PubMed1990

[Personal observations with application of auto-oxygenation techniques in the surgical management of coronary disease].

There were presented operative technique and clinical results of extracorporeal circulation (ECG) with patients lungs utilization, instead of routinely applied artificial blood oxygenators. Auto-oxygenation method was applied in 12 patients with coronary artery disease treated by coronary artery bypass grafting (CABG). Operative procedure differs from the traditional one in two additional cannulations of pulmonary artery and left atrium. Two peristaltic pumps and incorporated in circulation blood reservoirs. Polystan 892910 allows for temporary substitution of cardiac function without lung disconnection. Lungs functioning during surgery do not render it difficult. Hypothermia enables to decrease respiration rate and tidal volume with no effect on physiological blood oxygenation and CO2 exhalation. Method assessment was based on results comparison with those obtained in patients treated by traditional method using bubble oxygenators-Venotherm 5,000. PO2, PCO2, platelets number and hemolysis extent were assessed before, in 10, 30, 60 min of ECG and just after it. Platelets activity and influence of the method on hemostatic disorders were evaluated based on clotting time by Ivy. Additionally hemostatic disorders were assessed by thoracic blood drainage volume calculated from the moment of protamine administration to drainage tubes withdrawal in average 18 hours after surgery. Laboratory parameters characteristically changing during ECG were also estimated. It was proved, that auto-oxygenation diminished negative effects of ECG. Increased platelets number, faster normalization of clotting time and decreased postoperative drainage were stated in the auto-oxygenation group. Postoperative drainage in this group was 260 +/- 60 ml in comparison with 800 +/- 100 ml of the control group. Authors consider that pulmonary function remaining during ECG positively affects on postoperative hemostasis. This method can be helpful in surgical management of coronary artery disease, especially in patients with primary coagulation disorders.

Coronary Artery Bypass↗
PubMed1990

What do we gain by modifying risk factors for coronary disease?

There is no doubt about the association between coronary heart disease (CHD) and smoking, high serum cholesterol and high blood pressure, but association does not mean causation. To prove causation we must mount intervention trials and show that changing a risk marker changes total mortality: a) Trials of dietary reduction of serum lipids: The US Veterans dietary study and the North Karelia project showed no significant reduction in total mortality, nor did the Multiple Risk Factor Intervention Trial (MRFIT) or the WHO "paired-factories" Collaborative Group Study, where other risk factors were also being corrected. In the latter study there was a barely significant reduction in non-fatal CHD but fatal CHD, like total mortality was unchanged. b) Trials of lipid-lowering drugs: The first large-scale study, using clofibrate, showed an increase in total mortality; the screening of 500,000 men and the comparison of cholestyramine with placebo for the top 5% of lipid levels resulted in 68 deaths on the active resin and 71 on placebo. Less expensive measures (alcohol testing; safer roads) could surely do more good to half a million men? These 3 lives "saved" were "lost" in the Helsinki gemfibrozil study where there were 45 deaths in the active group and 42 in the placebo group. c) Effect of blood-pressure reduction. The assumption that reducing a risk marker will reduce CHD was challenged by the massive MRC Mild-to-Moderate Hypertension trial which showed no significant effect of treatment on CHD, CHD death or total mortality, even though stroke mortality was modestly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed2005

Interaction of body mass index and framingham risk score in predicting incident coronary disease in families.

BACKGROUND: Siblings of individuals with premature coronary heart disease (CHD) have a marked excess risk of CHD risk factors and premature CHD. The impact of body mass index (BMI) on incident CHD in these families and the extent to which it may be mediated by associated risk factors are unknown. The aim of this study was to examine the effect of high BMI on incident CHD in white and black families with premature CHD and to estimate the heritability of BMI. METHODS AND RESULTS: Risk factors, BMI, and Framingham Risk Score (FRS) were assessed at baseline and incident CHD was determined prospectively in 827 apparently healthy siblings of probands with premature CHD aged <60 years. During a mean follow-up of 8.7 years, 13.3% of siblings had incident CHD events. Event rates were higher in obese and overweight siblings than in those with normal weight (15.3% and 16.0% versus 8.1%, respectively; P=0.01). Multivariable Cox proportional hazards analyses demonstrated the independent prognostic value of BMI when added to FRS (P=0.02). A marked interaction between obesity (BMI > or =30 kg/m2) and high FRS (>20%) was seen for incident CHD (P for interaction=0.008), with an adjusted hazard ratio compared with low-FRS/normal-weight siblings of 14.63 (95% CI, 6.40 to 33.44; P<0.0001). BMI heritability (h2) was moderate for whites and low for blacks (52% and 29%, respectively). CONCLUSIONS: High BMI contributed independently and significantly to incident CHD, beginning in the overweight range, and was most notable for obese siblings with a high-risk FRS.

Adult↗
PubMed1981

Hemodynamic actions of prenalterol in severe congestive heart failure due to chronic coronary disease.

To provide improved inotropic agents for enhanced therapy of severe congestive heart failure (CHF), the hemodynamic efficacy of prenalterol (PN), a recently developed cardioselective beta-1 receptor agonist, was evaluated by cardiac catheterization in nine patients with refractory CHF due to chronic coronary disease. PN (4.8 mg intravenously) markedly augmented the cardiac index from 1.9 to 2.6 L/min/m2 (p less than 0.01) and substantially elevated stroke index from 24 to 30 ml/beat/m2 (p less than 0.001). Additionally, PN raised stroke work index 21 to 26 gm.m/m2 (p less than 0.005) and decreased total systemic vascular resistance from 1,702 to 1,260 dynes-sec cm(-5) (p less than 0.001). Concomitantly, heart rate, mean blood pressure, and left ventricular filling pressure were unaltered ( p greater than 0.05). Importantly, the heart rate-systolic blood pressure product was unchanged (p less than 0.05), and precipitation of cardiac dysrhythmias or myocardial ischemia was not observed. Thus PN produced considerable improvement of depressed cardiocirculatory performance without untoward effects and thereby appears a valuable new cardiotonic in the clinical management of severe low output ventricular dysfunction.

Aged↗
PubMed1975

[Coronary disease. I. A correlative study on hemodynamics and contactility in 110 patients].

Hemodynamics measures and indices of myocardial contractility were determined in 110 patients with coronary heart disease. In comparison to a normal group (n=20) right heart pressures (right ventricle, arteria pulmonalis) were increased in coronary heart disease by 48-71%. Systolic aortic pressure was increased by 20-22%. Left ventricular enddiastolic pressure was consideraibly increased by 130%, dependent on the severity degree of coronary artery disease. Cardiac output and cardiac index were decreased at comparable heart rate by 20-33%, dependent on an effective decrease of stroke volume. Isovolumic indices of myocardial contractility (dp/dtmax, t-dp/dtmax, dpmax/IP) WERE REDUCED IN CORONARY HEART DISEASE PARALLEl to the severity degree of coronary artery stenosis. All the hemodynamic chances were most pronounced in a group with left ventricular aneurysm. The results demonstrate that myocardial performance in coronary heart disease is characterized by decreases of pump function and contractility in correlation with the severity degree of coronary artery stenosis.

Adult↗
PubMed2003

Acute coronary disease Athero-Inflammation: Therapeutic approach.

Antithrombotic therapy is the cornerstone of the treatment of acute coronary syndromes, but there is now evidence which indicates that by blocking inflammation, thrombosis and thus, acute coronary events, could be lowered. The concept of athero-inflammation emerges as the meeting point of different morbidities; dyslipemia, diabetes, hypertension, obesity, immunity, infection, hyperhomocyteinemia, smoking, etc. usual named as risk factors. Thus, beside specific drugs, earliest treatment, in the stage of inflammation, using anti-inflammatory drugs, should be considered since in patients with increased risk of acute coronary process are likely to have many point of origen throughout the coronary arteries. There are a body of evidences for supporting the potential of anti-inflammatory therapy to the prevention of inflammation and atherosclerosis. COX-2 inhibition may decrease endothelial inflammation reducing monocytes infiltration improving vascular cells function, plaque stability and probably resulting in a decrease of coronary atherothrombotic events.Trials including large numbers of patients in prospective double-blind randomized studies worthwhile to confirm the efficacy of NSAID, mainly, COX-2 inhibitors, together with aspirin in the prevention of coronary events in patients with acute coronary disease.

Journal Article↗
PubMed1998

[Combined therapy with cholestyramine and HMG-CoA reductase inhibitors in secondary prevention of coronary disease].

PURPOSE: To evaluate lipid profile changes associated with cholestyramine addition in hypercholesterolemic patients with established coronary heart disease under treatment with HMG-CoA reductase inhibitors that had not achieved the ideal value of LDL-cholesterol. METHODS: Twenty patients with coronary heart disease, (12 submitted to coronary artery bypass grafts, 3 to coronary angioplasty and 5 maintained under clinical management) with mean age of 60.78 years old, who were under hypolipemic diet and were medicated with lovastatin 20 mg/d or simvastatin 10 mg/d, received cholestyramine, doses ranging from 8 to 16 g/day during 8 weeks, aiming to reduce LDL-cholesterol to values less than 100 mg/dL. RESULTS: There was a significant reduction of total cholesterol, from initial mean value of 239.52 mg/dL to final mean value of 199.00 mg/dL, with a mean reduction of 16.92%. The mean value of LDL-cholesterol was also reduced significantly from 172.73 mg/dL to 118.26 mg/dL, with a mean reduction of 31.53%. Mean triglyceridemia increased, still within the normal reference values, from 145.05 mg/dL to 162.00 mg/dL, and the mean difference was 11.69%. There was a significant increase of HDL-cholesterol fraction from an initial mean value of 38.00 mg/dL to a final mean value of 48.21 mg/dL, mean difference of 26.87%. Side effects were not frequent, and did not interfere in the duration of the study. CONCLUSION: The association of cholestyramine to HMG-CoA reductase inhibitors, both in low doses, in patients with primary hypercholesterolemia and high coronary risk is a good therapeutic option that can reach benefits on the lipid profile similar to those obtained when these drugs are used in association or separately in higher doses.

Anticholesteremic Agents↗
PubMed2001

Polymorphism in the fractalkine receptor CX3CR1 as a genetic risk factor for coronary artery disease.

Coronary atherosclerosis is a major cause of death in industrialized countries. Monocytes, which play a key role in atherosclerosis, migrate into the vessel wall, presumably guided by specific chemoattractant and adhesion molecules. A compelling candidate for this role is the chemokine receptor CX3CR1, which is expressed on monocytes and acts as either a chemotactic receptor or an adhesion molecule, depending on whether its ligand, fractalkine, is presented free or membrane bound. A common variant of CX3CR1 was recently identified, encoded by the alleles I249 and M280, which form a common I(249)M(280) haplotype. When CX3CR1 genotypes were analyzed in 151 patients with acute coronary syndromes and in 249 healthy controls, CX3CR1 I249 heterozygosity was associated with a markedly reduced risk of acute coronary events, independent of established acquired coronary risk factors (eg, smoking, diabetes). The adjusted odds ratio for this allele was 0.43 (95% confidence interval, 0.26-0.72; P =.001). Consistent with this, functional analysis of peripheral blood mononuclear cells showed that CX3CR1 I249 heterozygosity was associated with a significant decrease in the number of fractalkine binding sites per cell. The results show that CX3CR1 I249 is an independent genetic risk factor for coronary artery disease and that CX3CR1 may be involved in the pathogenesis of atherosclerotic disease. (Blood. 2001;97:1925-1928)

Acute Disease↗