Clinical cornerstone最新文献

{"title":"Overweight and obesity: The pathogenesis of cardiometabolic risk","authors":"George A. Bray MD (Professor of Medicine),&nbsp;Michael B. Clearfield DO, FACOI (Dean),&nbsp;Dan J. Fintel MD (Associate Professor of Medicine),&nbsp;Donald S. Nelinson PhD (Chief Scientific Officer)","doi":"10.1016/S1098-3597(09)80003-3","DOIUrl":"10.1016/S1098-3597(09)80003-3","url":null,"abstract":"<div><p>Obesity, particularly abdominal adiposity, is increasingly recognized as a cause of elevated cardiometabolic risk—the risk of developing type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). The predominate mechanisms appear to involve the promotion of insulin resistance, driven largely by excess free fatty acids secreted by an expanded adipose tissue mass, and the development of an inflammatory milieu due to increased secretion of inflammatory cytokines and adipokines from adipose tissue. Key proinflammatory cytokines secreted by adipocytes include tumor necrosis factor-α, interleukin-6, leptin, resistin, and plasminogen activator inhibitor-1. All have been variously associated with hyperinsulemia, hyperglycemia, insulin resistance, diabetes, and endothelial dysfunction, as well as plaque development, progression, and rupture. Adiponectin, another important adipocyte, has protective cardiometabolic actions; however, adiponectin levels decline with increasing obesity. Understanding the role of obesity in the pathogenesis of cardiometabolic risk is crucial for the development of treatment strategies that will provide maximum benefit for patients with, or at risk for, type 2 DM and CVD.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 4","pages":"Pages 30-42"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80003-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40043233","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":"Treatment of overweight and obesity: Lifestyle, pharmacologic, and surgical options","authors":"Christopher P. Cannon MD (Senior Investigator, TIMI Study Group Associate Professor of Medicine),&nbsp;Amit Kumar MD (Assistant Professor)","doi":"10.1016/S1098-3597(09)80005-7","DOIUrl":"10.1016/S1098-3597(09)80005-7","url":null,"abstract":"<div><p>Recent statistics indicate that overweight and obesity have become an increasingly serious clinical and socioeconomic problem worldwide, and one of the greatest public health challenges of our time. In the United States, 133.6 million (66%) adults are overweight or obese (body mass index [BMI] ≥25 kg/m²), with 63.3 million (31.4%) considered to be obese (BMI ≥30 kg/m²). The International Obesity Task Force estimates that worldwide at least 1.1 billion adults are overweight, including 312 million who are obese. Overweight and obese patients are at an increased risk for developing numerous cardiometabolic complications, including hypertension, type 2 diabetes mellitus, dyslipidemia, and cardiovascular diseases, as well as conditions such as osteoarthritis, obstructive sleep apnea, hepatobiliary diseases, and certain types of cancers. Owing to the major health risks and complications associated with obesity, which negatively affect quality of life and reduce average life expectancy, in addition to placing an enormous burden on health care resources, the treatment of overweight and obesity is a public health imperative. Treatment must begin with long-term lifestyle changes, including increased physical activity and dietary modifications. For overweight and obese individuals for whom lifestyle changes alone are insufficient, pharmacotherapy may be added. However, patients who choose adjunctive pharmacotherapy should be advised of the risks and benefits of drug therapy, the lack of long-term safety data, and the temporary and modest nature of the weight loss that can be achieved with these agents. Bariatric surgery is an effective treatment option for morbidly obese patients or obese patients with multiple comorbidities who have not been successful in achieving sufficient weight loss with nonsurgical approaches. However, appropriate candidates for bariatric surgery must also be committed to long-term lifestyle changes.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 4","pages":"Pages 55-71"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80005-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40043177","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":"Hydrofluoroalkane mandate in effect January 1, 2009: Switch from chlorofluorocarbon- to hydrofluoroalkane-propelled inhalers requires active transition","authors":"Stephen Peters MD, PhD (Professor of Medicine & Pediatrics)","doi":"10.1016/S1098-3597(09)80013-6","DOIUrl":"10.1016/S1098-3597(09)80013-6","url":null,"abstract":"<div><p>The manufacture, sale, and distribution of chlorofluorocarbon-propelled albuterol metered-dose inhalers ceased as of December 31, 2008. Clinicians should actively transition patients to currently available hydrofluoroalkane-propelled devices, providing concise education and instruction for using the newer devices.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 50-53"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80013-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40035975","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":"A 12-year-old student athlete with exercise-induced bronchospasm: Getting Jenny B. Back on track","authors":"Giselle Mosnaim MD, MS (Assistant Professor)","doi":"10.1016/S1098-3597(09)80010-0","DOIUrl":"https://doi.org/10.1016/S1098-3597(09)80010-0","url":null,"abstract":"<div><p>Jenny B. is an active 12-year-old white female who recently stopped participating in junior high school track because of respiratory symptoms she experiences while running. On presentation to her pediatrician's office for a consultation, it immediately became apparent that she was anxious to rejoin her team to compete. This article will navigate through a patient case and explore multiple clinical approaches to exercise-induced broncho-spasm from diagnosis to treatment. As clinicians, our goal is to partner with all patients who experience asthma or respiratory symptoms, enabling them to have a life without limitations. Let us review Jenny B.'s case and examine what might be the best approach to get her back on track.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 30-39"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80010-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91635254","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":"Recent Advances in Cardiovascular Risk Reduction: Implications of ONTARGET","authors":"Robert Guthrie MD","doi":"10.1016/S1098-3597(09)60015-6","DOIUrl":"10.1016/S1098-3597(09)60015-6","url":null,"abstract":"<div><p><span><span><span>Renin-angiotensin-aldosterone system (RAAS) overactivity is associated with increased cardiovascular risk, a finding that may be explained by the key role of the RAAS in stimulating vascular and cardiac remodeling<span>. Inhibition of RAAS activity with the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers<span> (ARBs) has been shown to reduce cardiovascular mortality </span></span></span>in patients with heart failure. ACE inhibitors have also been shown to reduce the incidence of stroke, myocardial infarction (MI), and heart failure in high-risk patients without heart failure. These findings led to the evaluation of the ARB </span>telmisartan versus the ACE inhibitor </span>ramipril<span> in the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), a cardioprotection trial conducted in high-risk patients without left ventricular dysfunction or heart failure. The results of this trial showed that the ACE inhibitor ramipril and the ARB telmisartan are equally effective in reducing the incidence of cardiovascular death, MI, stroke, and hospitalization for heart failure in patients without heart failure or left ventricular dysfunction but at high risk for cardiovascular disease (CVD). These results confirm that RAAS inhibition, using ACE inhibitors or ARBs, is an effective approach to reducing cardiovascular mortality and morbidity in patients without heart failure who are at high risk for CVD.</span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S18-S26"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60015-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28146485","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":"Obesity as a disease state: A new paradigm for diagnosis and treatment","authors":"Louis J. Aronne MD (Clinical Professor of Medicine),&nbsp;Donald S. Nelinson PhD (Chief Scientific Officer),&nbsp;Joseph L. Lillo DO (Assistant Professor of Family Medicine)","doi":"10.1016/S1098-3597(09)80002-1","DOIUrl":"10.1016/S1098-3597(09)80002-1","url":null,"abstract":"<div><p>While global prevalence of obesity continues to increase dramatically, treatment options remain less than optimal. The etiology of obesity is multifactorial, ranging from lifestyle choices such as excess food intake and insufficient physical activity, to use of medications that have weight gain as an undesirable side effect. Economic and political determinants of available foodstuffs and even social networks may also contribute to obesity. Successful management of obesity requires the understanding and acceptance of a new paradigm that identifies obesity as a disease—one defined by waist circumference—that requires treatment. Obesity meets all accepted criteria of a medical disease, including a known etiology, recognized signs and symptoms, and a range of structural and functional changes that culminate in pathologic consequences. Excess adipose tissue acts as an endocrine organ to produce excess free fatty acids, as well as tumor necrosis factor-α, interleukin-6, leptin, and plasminogen activator inhibitor-1. These bioactive molecules are associated with hyperinsulinemia, hyperglycemia, insulin resistance, development of diabetes, endothelial damage, and the onset and progression of atherosclerotic lesions. Options for treating obesity include lifestyle modifications (dietary changes, increased physical activity, behavior modification) and, for the morbidly obese, surgery. Lifestyle modification is rarely successful over the long term; therefore, addition of pharmacotherapy should be considered for obese individuals who have difficulty achieving and maintaining weight goals with lifestyle modifications alone. Several weight loss drugs are available for long-term use, with others in various stages of clinical development.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 4","pages":"Pages 9-29"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80002-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40043232","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":"Guiding clinical decisions on abdominal obesity and cardiometabolic risk","authors":"Richard W. Nesto MD (Chair, Department of Cardiovascular Medicine Lahey Clinic Medical Center Burlington, Massachusetts Associate Professor of Medicine),&nbsp;Donald S. Nelinson PhD (Chief Scientific Officer),&nbsp;Uberto Pagotto MD, PhD (Assistant Professor)","doi":"10.1016/S1098-3597(09)80004-5","DOIUrl":"10.1016/S1098-3597(09)80004-5","url":null,"abstract":"<div><p>Studies have shown that obesity increases cardiometabolic risk across the span of life. Obesity results in increased production of proinflammatory adipokines and decreased production of the anti-inflammatory adi-pokine, adiponectin, which eventually leads to atherosclerosis and type 2 diabetes mellitus. Lifestyle changes are the cornerstone for treatment of overweight and obese patients; however, pharmacotherapy and surgery are 2 additional treatment options that may be considered when lifestyle changes alone are unsuccessful. Adipose tissue, particularly central adipose tissue, is an endocrine organ, the actions of which tie together all components of cardiometabolic risk. Weight loss reduces levels of most proinflammatory adipokines, attenuates inflammation, improves endothelial function, and enhances insulin sensitivity. In view of these effects, obesity represents an obvious target for pharmacologic intervention. However, the benefits associated with the pharmacologic management of weight loss must be weighed against the potential for drug-related adverse events.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 4","pages":"Pages 43-54"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80004-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40043234","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 Management of Hypertension With Angiotensin Receptor Blockers in Special Populations","authors":"Keith C. Ferdinand Md, FACC ,&nbsp;Cheryl Taylor PhD, RN","doi":"10.1016/S1098-3597(09)60014-4","DOIUrl":"10.1016/S1098-3597(09)60014-4","url":null,"abstract":"<div><p><span><span>Angiotensin receptor blockers (ARBs) are the most recently approved major class of </span>antihypertensive agents. The primary mechanism of action of ARBs is the selective blockade of the AT</span>₁<span> receptor. There are 7 ARBs presently approved for clinical use in the United States, several with other indications in addition to blood pressure reduction<span> in patients<span><span> with hypertension. While ARBs appear to be no more potent than angiotensin-converting enzyme inhibitors for lowering blood pressure when used as monotherapy, they are a beneficial alternative and even compelling in certain populations. This class of agents also has the added benefit of placebo-like side effects, potentially enhancing adherence. In this review, studies are presented as positive evidence supporting the use of ARBs in special populations (including persons with diabetic nephropathy), in patients with heart failure (especially with systolic dysfunction), for cardioprotection in high-risk cardiac patients (including postmyocardial infarction and stroke), and for delaying new-onset diabetes. Clinical information on the effects of ARBs related to race and ethnicity are also discussed, although the data in most large trials are not substantial. Despite the fact that African American patients have the highest prevalence of hypertension (with increased mortality and morbidity), studies have been less robust regarding ARBs and protection against cardiovascular disease in this population. Although at least 1 major study has confirmed the benefit of ARBs in Asian patients with </span>diabetic nephropathy, overall, treating patients based on race and ethnicity remains fraught with difficulty.</span></span></span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S5-S17"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60014-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28146489","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":"Hydrofluoroalkane tear-out sheet","authors":"","doi":"10.1016/S1098-3597(09)80015-X","DOIUrl":"https://doi.org/10.1016/S1098-3597(09)80015-X","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Page 61"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80015-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137405257","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":"Should clinicians routinely determine rhinitis subtype on initial diagnosis and evaluation? A debate among experts","authors":"Martin Quan MD (Professor of Clinical Family Medicine),&nbsp;Thomas B. Casale MD (Vice President, Respiratory & Allergic Disease Foundation Executive Vice President, American Academy of Allergy, Asthma, and Immunology Professor of Medicine Chief),&nbsp;Michael S. Blaiss MD (Clinical Professor of Pediatrics and Medicine)","doi":"10.1016/S1098-3597(09)80014-8","DOIUrl":"10.1016/S1098-3597(09)80014-8","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 54-60"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80014-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40035976","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}