Heart disease (Hagerstown, Md.)最新文献

{"title":"Gender, ethnicity and genetics in cardiovascular disease: part 1: Basic principles.","authors":"Benjamin M Schaefer,&nbsp;Vincent Caracciolo,&nbsp;William H Frishman,&nbsp;Pamela Charney","doi":"10.1097/01.hdx.0000061694.62343.01","DOIUrl":"https://doi.org/10.1097/01.hdx.0000061694.62343.01","url":null,"abstract":"<p><p>Prior to 1993, most drug efficacy and safety trials were conducted in white males, although gender and racial differences in pharmacodynamics and pharmacokinetics have been documented since the early 1900s. Over the last 2 decades, supported by the FDA and legislation, attempts to include more women and minorities in clinical drug trials have been made, with limited success. Yet, there are important differences in pathophysiology and pharmacogenetics, as well as pharmacotherapeutic effectiveness. This is the first of 2 articles that review the basic scientific principles of such differences. In particular, genetic polymorphisms of cardiovascular candidate genes and drug metabolism are described. The pharmacodynamic and pharmacokinetic variations among genders and ethnicities are summarized.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 2","pages":"129-43"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000061694.62343.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22356580","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":"Aldosterone and aldosterone antagonism in cardiovascular disease: focus on eplerenone (Inspra).","authors":"Charles T Stier,&nbsp;Seth Koenig,&nbsp;Davis Y Lee,&nbsp;Mohit Chawla,&nbsp;William H Frishman","doi":"10.1097/01.hdx.0000061698.20666.aa","DOIUrl":"https://doi.org/10.1097/01.hdx.0000061698.20666.aa","url":null,"abstract":"<p><p>Aldosterone has long been known to mediate water and electrolyte balance by acting on mineralocorticoid receptors in the kidneys. However, recent studies have demonstrated the presence of these receptors in nonclassical locations, including the brain, blood vessels, and the heart. This finding suggests that aldosterone may play a larger role than once appreciated in normal physiologic function and cardiovascular disease. Some of the adverse cardiovascular effects that have been described include cardiac and vascular fibrosis, left ventricular hypertrophy, congestive heart failure, hypertension, endothelial dysfunction, reduced fibrinolysis, and cardiac arrhythmias. In light of these findings, aldosterone receptor blockers have become increasingly more important. This is especially true considering the fact that traditional therapies, such as angiotensin-converting enzyme inhibitors and angiotensin II-receptor blockers, may not be effective in maintaining long-term suppression of aldosterone. Therefore, a great deal of focus has been placed on spironolactone, which has proven to be an effective, albeit nonselective, aldosterone receptor blocker. The Randomized Aldactone Evaluation Study has shown that spironolactone results in a 30% reduction in mortality among patients with severe congestive heart failure. Other studies have shown spironolactone to lower high blood pressure, improve endothelial dysfunction, reduce left ventricular hypertrophy, and lower the incidence of fatal arrhythmias. However, spironolactone, because of its interaction with other steroid receptors, is not without its limitations, which include gynecomastia, breast tenderness, menstrual irregularities, and impotence. As a result, eplerenone (INSPRA), a selective aldosterone blocker, is currently being investigated for its efficacy and side-effect profile compared with spironolactone. Eplerenone has already been approved for the treatment of systemic hypertension, and several clinical trials are currently underway to identify other therapeutic uses for this agent in cardiovascular disease management.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 2","pages":"102-18"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000061698.20666.aa","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22356576","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":"Diabetes mellitus and coronary artery disease: therapeutic considerations.","authors":"Joydeep Ghosh,&nbsp;Melvin B Weiss,&nbsp;Richard H Kay,&nbsp;William H Frishman","doi":"10.1097/01.hdx.0000061699.60794.7d","DOIUrl":"https://doi.org/10.1097/01.hdx.0000061699.60794.7d","url":null,"abstract":"<p><p>Diabetes mellitus affects about 6% of the U.S. population and represents a significant public health challenge, with numbers of those affected increasing every year. The most common cause of death in these patients is macrovascular disease, with coronary disease being the predominant form. The pathophysiology of coronary disease in patients with diabetes is complex and involves elements of hyperglycemia, dyslipidemia, hyperinsulinemia, as well as a procoagulant vascular milieu. First-generation trials looking at revascularization of multivessel disease in patients with diabetes have had long clinical follow-up periods and seem to consistently favor coronary bypass grafting over percutaneous interventions; however, newer trials that include the use of stents and glycoprotein IIb/IIIa inhibitor therapy as part of the latter strategy have raised some interesting questions, so that the issue remains controversial and by no means settled.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 2","pages":"119-28"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000061699.60794.7d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22356577","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":"Influence of gender and reported alcohol intake on mortality in nonischemic dilated cardiomyopathy.","authors":"R F Faris,&nbsp;M Y Henein,&nbsp;A J S Coats","doi":"10.1097/01.hdx.0000061702.79961.47","DOIUrl":"https://doi.org/10.1097/01.hdx.0000061702.79961.47","url":null,"abstract":"<p><p>Between 1994-1998, we retrospectively studied a cohort of 396 consecutive patients with dilated cardiomyopathy, mean age 53 +/- 15 years, 74% men. The history of alcohol intake was abstracted from the medical records. During a follow-up period of 42 +/- 26 months, 83 (76% men) patients died and 15 (80% men) underwent cardiac transplantation. Men were younger and more likely to have a history of excessive alcohol intake compared with women. Gender significantly modified the risk of alcohol consumption on mortality. Although alcohol intake increased the mortality risk in women, it was protective toward death in men (hazards ratios for death were 7.3 vs. 0.44). The effect of alcohol intake on outcome was reassessed after classifying the patients into 4 groups: group 1: life-long nondrinkers; group 2: former drinkers; group 3: moderate drinkers; and group 4: heavy drinkers. Similar findings were seen. This study demonstrated that the risk of reported alcohol intake on mortality is related to gender in patients with nonischemic heart failure. Our findings deserve further study, including a larger number of females, as a possible way to improve outcome in such patients.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 2","pages":"89-94"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000061702.79961.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22357183","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":"Drug treatment of orthostatic hypotension and vasovagal syncope.","authors":"William H Frishman,&nbsp;Victor Azer,&nbsp;Domenic Sica","doi":"10.1097/01.HDX.0000050416.53995.43","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050416.53995.43","url":null,"abstract":"<p><p>Orthostatic hypotension is a common problem, estimated to occur in 5 out of every 1000 individuals and in as many as 7% to 17% of patients in an acute care setting. Moreover, orthostatic hypotension may be more prominent in elderly patients due to the increased intake of vasoactive medications and concomitant decrease in physiologic function, such as baroreceptor sensitivity, often seen with aging. Orthostatic hypotension is a fall in blood pressure on assuming an upright position. Absolute cutoffs for the drop in blood pressure are often difficult to determine because different patients exhibit varying degrees of tolerance to falls in blood pressure. Therefore, strict numerical criteria may lead to underdiagnosis and improper intervention. A thorough review of patient symptomatology combined with appropriate clinical tests should be employed to narrow the vast differential diagnosis and pinpoint the etiology. The fall in blood pressure seen in orthostatic hypotension results from the inability of the autonomic nervous system to adequately compensate for the 500 mL blood that is estimated to pool in the lower extremities on assuming an upright posture. The decrease in venous return results in a concomitant decrease in cardiac output and thus hypoperfusion of the cerebral circulation, possibly resulting in syncope or various other symptoms. A complete investigation should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders and, of course, vasovagal syncope, the most common cause of syncope. Although further research is still necessary to rectify the disease process responsible for orthostatic hypotension, patients suffering from this disorder can effectively be treated through a combination of nonpharmacologic treatment, pharmacologic treatment and patient education. Agents such as fludrocortisone, midodrine and erythropoietin show promising results as therapeutic adjuncts. Treatment for recurrent vasovagal syncope includes increased salt intake, and various drug treatments, most of which are still under investigation.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"49-64"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050416.53995.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215694","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":"Cerebral hyperperfusion after angioplasty and stenting of a totally occluded left subclavian artery: a case report.","authors":"Anthony L Pucillo,&nbsp;Nagaraju L Choragudi,&nbsp;Romeo B Mateo,&nbsp;John T Hughes,&nbsp;Wilbert S Aronow","doi":"10.1097/01.HDX.0000050409.81342.ED","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050409.81342.ED","url":null,"abstract":"<p><p>Cerebral hyperperfusion syndrome is documented after angioplasty of carotid and vertebral artery lesions. The authors report the first instance of cerebral hyperperfusion syndrome in the posterior cerebral circulation after angioplasty and stenting of a totally occluded left subclavian artery.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"15-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050409.81342.ED","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215690","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":"Rosuvastatin: a new HMG-CoA reductase inhibitor for the treatment of hypercholesterolemia.","authors":"Angela Cheng-Lai","doi":"10.1097/01.HDX.0000050417.89309.F8","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050417.89309.F8","url":null,"abstract":"<p><p>Because of their excellent tolerability and their positive impact on lipid parameters, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have become the drugs of first choice for many patients with dyslipidemia. Rosuvastatin is an investigational statin in the U.S. with a number of favorable characteristics, which include low lipophilicity, high hepatocyte selectivity, minimal metabolism, and a low propensity for cytochrome P450 drug interactions. Rosuvastatin has been studied at doses ranging from 1 to 80 mg. In comparative clinical trials, rosuvastatin given at 5 to 10 mg/day reduced low-density lipoprotein cholesterol to a significantly greater extent than atorvastatin 10 mg/day, pravastatin 20 mg/day, and simvastatin 20 mg/day. In addition, rosuvastatin exhibited beneficial effects on other lipid parameters such as high-density lipoprotein cholesterol and triglycerides. Rosuvastatin's safety profile was demonstrated to be similar to those of other statins. Given its favorable pharmacokinetic and pharmacodynamic characteristics, rosuvastatin is likely to become a valuable addition to the statin drug class. The author reviews the pharmacologic and pharmacokinetic properties of this new statin.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"72-8"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050417.89309.F8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215696","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":"Racial variations in cardiology care among hospitalized older heart failure patients.","authors":"Ali Ahmed,&nbsp;Richard V Sims,&nbsp;Richard M Allman,&nbsp;James F DeLong,&nbsp;Wilbert S Aronow","doi":"10.1097/01.HDX.0000050408.07809.45","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050408.07809.45","url":null,"abstract":"<p><p>In this retrospective follow-up study, the authors examined the association between race and the receipt of cardiology care in 1062 Medicare beneficiaries 65 years of age and older who were hospitalized with heart failure. The primary outcome measure was receipt of care from a cardiologist (via admission or consultation). Using logistic regression analyses, crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) of receipt of cardiology care were estimated for nonwhite versus white patients. Two hundred (19%) patients were nonwhites and 483 (46%) patients received care from cardiologists. Proportion of patients receiving cardiology care was lower among nonwhite patients (35% versus 48% among whites; P = 0.001), and nonwhite race was associated with a lower odds of receiving cardiology care (crude OR = 0.57; 95%CI = 0.42-0.79). After adjustment for various patient characteristics and process-of-care variables, the magnitude and precision of the association between nonwhite race and a lower odds of receiving care from a cardiologist remained unchanged (adjusted OR = 0.43; 95% CI = 0.30-0.62). These findings suggest that nonwhite elderly hospitalized heart failure patients are less likely to be cared for by cardiologists.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"8-14"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050408.07809.45","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215221","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":"hsCRP and HDL effects of statins trial (CHEST): rapid effect of statin therapy on C-reactive protein and high-density lipoprotein levels A clinical investigation.","authors":"Benjamin J Ansell,&nbsp;Karol E Watson,&nbsp;Robert E Weiss,&nbsp;Gregg C Fonarow","doi":"10.1097/01.HDX.0000050407.62572.DE","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050407.62572.DE","url":null,"abstract":"<p><p>Inflammation contributes to the pathogenesis of coronary heart disease and elevated serum levels of C-reactive protein (CRP) are independently associated with increased coronary risk. This study assessed whether there were differences in the effects on CRP and high-density lipoprotein (HDL) cholesterol levels among patients treated with three common statins. In a prospective, observational study, 80 dyslipidemic adults without evidence of cardiovascular disease were treated with 10 mg atorvastatin (A), 20 mg simvastatin (S), or 40 mg pravastatin (P) daily. CRP and lipid profiles were assayed before and after 12 weeks of therapy; in 21 patients, CRP levels were also measured after 1 and 4 weeks. The three treatment groups experienced comparable reductions in CRP (A: 33%, S: 42%, and P: 30%) and statistically insignificant changes in HDL cholesterol levels. CRP began to decrease after 1 week of treatment, and decreased further at 4 and 12 weeks of therapy. The change in the log-transformed CRP concentration correlated with the change in the log-transformed LDL cholesterol concentration. Subjects had similar baseline CRP levels, lipid profiles, and coronary risk factors. The authors conclude that at doses achieving similar reductions in LDL cholesterol, the three statins were associated with comparable decreases in CRP without significant changes in HDL cholesterol levels. The correlation between the reductions in CRP and LDL cholesterol differs from the findings of other published studies, and should prompt further investigation of the mechanism by which statins reduce CRP.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050407.62572.DE","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215220","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":"Pharmacotherapeutic considerations in anesthesia.","authors":"Sheldon Goldstein,&nbsp;David Amar","doi":"10.1097/01.HDX.0000050410.54258.24","DOIUrl":"https://doi.org/10.1097/01.HDX.0000050410.54258.24","url":null,"abstract":"<p><p>This article focuses on new findings leading to improved understanding of the pathophysiology and mechanisms of potential drug interactions between anesthetic drugs or techniques and cardiovascular medications in patients scheduled for surgery. Only the most frequently used drugs are reviewed. Elective surgery provides the luxury to consider these risks and alter therapy accordingly. Under urgent circumstances, however, the increased risks associated with these agents should be anticipated with the goal to minimize adverse effects while maintaining optimal cardiovascular function in the perioperative period.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 1","pages":"34-48"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.HDX.0000050410.54258.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22215692","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}