The Canadian journal of cardiology最新文献

{"title":"The 'double dip' hypothesis: simultaneous prevention of cardiovascular and pulmonary morbidity and mortality using angiotensin II type 1 receptor blockers.","authors":"G B John Mancini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The therapy for chronic obstructive lung disease (COPD) is largely symptomatic in nature, involving the use of bronchodilators and steroids, and the judicious use of antibiotics. None of these have been shown to have a consistent beneficial impact on outcome. Moreover, the outcome of patients with COPD is determined, to some extent, by the occurrence of cardiovascular events. The association between pulmonary disease and cardiovascular events is gaining greater recognition, and appears inexplicable solely on the basis of shared, traditional risk factors, such as smoking. There appear to be direct links between lung injury and concomitant vascular injury by virtue of a systemic inflammatory state induced by lung inflammation. The present paper raises the possibility that the outcome of patients with COPD may be improved significantly through aggressive use of therapies known to prevent cardiovascular events. Moreover, angiotensin II is also a direct mediator of lung injury; interruption of this mechanism of injury might simultaneously prevent both cardiovascular and pulmonary morbidity and mortality in patients with chronic lung disease.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"519-23"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between a low glycemic load diet and a Canada Food Guide diet in cardiac rehabilitation patients in Ontario.","authors":"Stephen A LaHaye,&nbsp;Peter M Hollett,&nbsp;John R Vyselaar,&nbsp;M Shalchi,&nbsp;Karen A Lahey,&nbsp;Andrew G Day","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A high dietary glycemic load is associated with an increased risk of noninsulin-dependent diabetes mellitus and coronary artery disease.</p><p><strong>Objective: </strong>To evaluate the effect of a low glycemic load diet on cardiac rehabilitation patients.</p><p><strong>Methods: </strong>One hundred twenty patients who were advised to follow a low glycemic load diet were evaluated and compared with 1434 patients who were advised to follow the principles of Canada's Food Guide to Healthy Eating for People Four Years and Over as part of the Ontario Cardiac Rehabilitation Pilot Project.</p><p><strong>Results: </strong>Patients on the low glycemic load diet lost more weight at six months (2.8 kg loss versus 0.2 kg gain, P < 0.0001), had a greater reduction in abdominal obesity (2.9 cm versus 0.4 cm, P < 0.0001), and had a greater improvement in high density lipoprotein cholesterol (0.14 mmol/L versus 0.02 mmol/L, P < 0.0001), triglycerides (-0.44 mmol/L versus -0.08 mmol/L, P < 0.0001) and glycemic control (fasting glucose -0.94 mmol/L versus 0.91 mmol/L, P = 0.0019). After one year of follow-up, the low glycemic load patients had maintained (weight gain 0.7 kg, triglycerides -0.07 mmol/L, fasting glucose -0.10 mmol/L and glycosylated hemoglobin A1c -0.18%; all not significant) or augmented (waist circumference -1.3 cm, P = 0.038; high density lipoprotein cholesterol 0.08 mmol/L, P < 0.0001) the initial results.</p><p><strong>Conclusions: </strong>Implementation of a low glycemic load diet was associated with substantial and sustained improvements in abdominal obesity, cholesterol and glycemic control.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"489-94"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic potential of novel Na+-Ca2+ exchange inhibitors in attenuating ischemia-reperfusion injury.","authors":"Candace Lee,&nbsp;Naranjan S Dhalla,&nbsp;Larry V Hryshko","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The cardiac Na+-Ca2+ exchanger (NCX) plays an essential role in regulating Ca2+ under physiological and pathophysiological conditions. In its forward mode of operation, which predominates under physiological conditions, it extrudes the Ca2+ that enters the cardiac myocyte on a beat-to-beat basis. During ischemia and reperfusion, increased intracellular Na+ leads to a decrease in Ca2+ efflux and enhanced Ca2+ influx via the NCX, potentially leading to Ca2+ overload, which is one of the major pathophysiological mechanisms for ischemia-reperfusion injury. Novel NCX inhibitors discovered in recent years have shown great promise in attenuating ischemia-reperfusion injury.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"509-16"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to statins, beta-blockers and angiotensin-converting enzyme inhibitors following a first cardiovascular event: a retrospective cohort study.","authors":"David F Blackburn,&nbsp;Roy T Dobson,&nbsp;James L Blackburn,&nbsp;Thomas W Wilson,&nbsp;Mary Rose Stang,&nbsp;William M Semchuk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Population studies of statin adherence are generally restricted to one to two years of follow-up and do not analyze adherence to other drugs.</p><p><strong>Objectives: </strong>To report long-term adherence rates for statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in patients who recently experienced a first cardiovascular event.</p><p><strong>Methods: </strong>Linked administrative databases in the province of Saskatchewan were used in this retrospective cohort study. Eligible patients received a new statin prescription within one year of their first cardiovascular event between 1994 and 2001. Adherence to statins, beta-blockers and ACE inhibitors was assessed from the first statin prescription to a subsequent cardiovascular event.</p><p><strong>Results: </strong>Of 1221 eligible patients, the proportion of patients adherent to statin medications dropped to 60.3% at one year and 48.8% at five years. The decline in the proportion of adherent patients was most notable during the first two years (100% to 53.7%). Several factors were associated with statin adherence, including age (P = 0.012), number of physician service days (P = 0.037), chronic disease score (P = 0.032), beta-blocker adherence (P < 0.001) and ACE inhibitor adherence (P < 0.001). Adherence to beta-blockers and ACE inhibitors was very similar to adherence to statin medications at each year of follow-up.</p><p><strong>Conclusions: </strong>Patients who exhibit optimal adherence over one to two years after their initial cardiovascular event generally remain adherent over subsequent years. Also, adherence to beta-blockers and ACE inhibitors is significantly associated with statin adherence in a subset of patients; however, overall adherence to all three drugs was similarly poor.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"485-8"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enoxaparin and percutaneous coronary intervention: a Canadian perspective.","authors":"David Fitchett,&nbsp;Robert Welsh,&nbsp;Anatoly Langer,&nbsp;Shaun Goodman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The low molecular weight heparin enoxaparin is commonly used in the management of patients with non-ST segment elevation acute coronary syndromes (ACS). It is perceived that there is variable acceptance of the use of enoxaparin in patients with ACS in conjunction with percutaneous coronary intervention (PCI) by Canadian interventional cardiologists, as well as diverse approaches to the procedural (ie, PCI) management of anticoagulation.</p><p><strong>Methods and results: </strong>A survey assessing physician and centre demographics, as well as the opinion and approach to the use of enoxaparin in patients undergoing PCI, was developed. All 141 interventional cardiologists performing PCI in Canada were sent the survey, with a 52% response rate. The majority (64%) of respondents were comfortable performing PCI during enoxaparin treatment, but almost one-half (46.5%) stated a preference to have a point-of-care measurement of the anticoagulation level during the procedure. Various 'top-up' protocols are used across the country, including fixed-dose intravenous (IV) enoxaparin, weight-adjusted IV enoxaparin, fixed-dose IV unfractionated heparin, weight-adjusted IV unfractionated heparin and IV unfractionated heparin titrated to a target activated clotting time. Although the median time threshold for administering a 'top-up' dose of anticoagulation matched current recommendations, there was a wide variation ranging from 2 h to 10 h (median 8 h).</p><p><strong>Conclusions: </strong>Although the majority of Canadian interventional cardiologists were comfortable performing PCI in patients treated with enoxaparin, the survey demonstrated various levels of confidence and a diverse range of 'top-up' anticoagulation procedures. Nationwide guidelines for the management of anticoagulation in patients with ACS undergoing PCI with enoxaparin should be developed from the best available clinical and research evidence to limit potential patient risk of inadequate or excessive anticoagulation. This is especially relevant in view of the association between switching among anticoagulant therapies and an increased bleeding risk in patients undergoing early cardiac catheterization and PCI that was found in the recently reported Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"501-7"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple cardiac metastases from Ewing's sarcoma.","authors":"Nair K Chandramohan,&nbsp;Misra B Hussain,&nbsp;Nileena Nayak,&nbsp;Jayasree Kattoor,&nbsp;Manjo Pandey,&nbsp;Ramachandran Krishnankutty","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ewing's sarcoma commonly arises from bone and sometimes from extraskeletal soft tissues. It commonly metastasizes to the lungs, bone, bone marrow and brain. Cardiac metastasis is extremely uncommon. The present report discusses a case of Ewing's sarcoma metastasizing to the heart at the time of initial presentation.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"525-7"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous origin of the left coronary artery with diffuse coronary hypoplasia resulting in sudden death.","authors":"Jacqueline Ho,&nbsp;Gareth Jevon,&nbsp;Shubhayan Sanatani","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A case of sudden death is reported in a 13-year-old boy due to an acute myocardial infarction and arrhythmias following exertion. On autopsy, he was found to have an anomalous origin of the left coronary artery, an acute angle of takeoff of the left coronary artery, and diffuse hypoplasia of both the left and right coronary arteries. Both arteries had markedly small lumens throughout their course. This report provides the first description of this combination of congenital coronary artery abnormalities resulting in sudden death.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"529-31"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of an anomalous left coronary artery arising from a dominant right coronary artery by 16-slice computed tomography in a 75-year-old woman.","authors":"Christof Burgstahler,&nbsp;Torsten Beck,&nbsp;Martin Heuschmid,&nbsp;Axel Kuettner,&nbsp;Andreas F Kopp,&nbsp;Stephen Schroeder","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"533"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained elevation of serum CD40 ligand levels one month after coronary angioplasty predicts angiographic restenosis.","authors":"Philippe L L'Allier,&nbsp;Jean-Claude Tardif,&nbsp;Jean Grégoire,&nbsp;Michel Joyal,&nbsp;Jacques Lespérance,&nbsp;Annik Fortier,&nbsp;Marie-Claude Guertin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention induces an early inflammatory reaction. The intensity of such a reaction as measured by high-sensitivity C-reactive protein has been correlated with recurrent ischemic events, but its association with restenosis remains uncertain.</p><p><strong>Objectives: </strong>To characterize the type and duration of the postangioplasty inflammatory reaction and to identify new inflammatory markers correlating with restenosis.</p><p><strong>Methods: </strong>Fifty-three consecutive patients who underwent successful balloon angioplasty were studied. Levels of specific inflammatory markers were measured before intervention, and at one-month and six-month follow-up. Six-month clinical and angiographic follow-up was conducted in all patients, and quantitative coronary analysis was systematically performed.</p><p><strong>Results: </strong>Levels of soluble CD40 ligand (sCD40L) and matrix metalloproteinase-2 showed a rise and fall pattern over six months, with peak levels measured at one month (P < 0.0001), while levels of soluble vascular cell adhesion molecule-1 increased after angioplasty and remained elevated at six months (P = 0.07). Plasma levels of sCD40L at one month correlated with angiographic late loss (r = 0.48, P = 0.001) and were predictive of six-month restenosis (area under receiver operating characteristic curve 0.75 [95% CI 0.61 to 0.88]).</p><p><strong>Conclusions: </strong>The results imply that inflammation persists for at least one month following angioplasty and that future therapeutic interventions targeting inflammation to prevent restenosis should be active during this period. Furthermore, the ability of sCD40L levels to predict restenosis at six months may indicate the relevance of this pathway as a therapeutic target for restenosis prevention.</p>","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"495-500"},"PeriodicalIF":6.2,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40932924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The number needed to harm: is it too optimistic?","authors":"G B John Mancini,&nbsp;Michael Schulzer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":505916,"journal":{"name":"The Canadian journal of cardiology","volume":" ","pages":"1375; author reply 1376"},"PeriodicalIF":6.2,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24872292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}