Heartdrug : excellence in cardiovascular trials最新文献

{"title":"Is the Use of Selective COX Inhibitors Associated with an Increased Risk of Cardiovascular Events?","authors":"J. Otterstad","doi":"10.1159/000077295","DOIUrl":"https://doi.org/10.1159/000077295","url":null,"abstract":"The assumption that long-term treatment with rofecoxib is associated with an increased cardiovascular risk when compared with naproxen is based upon a small number of events in the Vioxx Gastrointestinal Outcomes Research (VIGOR) study. That study, however, was not designed to assess adverse cardiovascular events. A review of the available literature does not support such an assumption. Further studies designed to elucidate whether treatment with cyclooxygenase 2 (COX-2) inhibitors is associated with an increased cardiovascular risk are needed. In patients with a high cardiovascular risk, treatment with COX-2 inhibitors should be combined with aspirin, while the combination of a conventional nonsteroidal anti-inflammatory drug and aspirin ought to be avoided due to an increased risk of adverse gastrointestinal effects.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"92 - 95"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65219779","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":"Changes in Peak Respiratory Flow and Quality of Life during Nebivolol Therapy","authors":"M. Zuber, P. Erne","doi":"10.1159/000077949","DOIUrl":"https://doi.org/10.1159/000077949","url":null,"abstract":"Background: Nebivolol is a highly cardioselective β1-adrenoceptor antagonist with proven efficacy and safety in the treatment of hypertension. This study aimed to specifically address the effects of nebivolol on lung function and quality of life in patients suffering from mild to moderate hypertension. Objectives: The study assessed the effects of nebivolol, taken alone or in combination with other antihypertensives for 12 weeks, on peak respiratory flow, libido, general health, and physical condition. The effects on blood pressure and heart rate were also determined. Methods: A total of 367 patients suffering from mild to moderate hypertension were enrolled in 93 private general practices. Changes in peak respiratory flow, blood pressure, and heart rate were recorded after 4 and 12 weeks. A questionnaire on items of sexual function, physical energy, and general health elicited the patients’ perception of their quality of life. Safety was assessed on the basis of adverse events. Results: After 4 and 12 weeks, peak respiratory flow was significantly increased in patients receiving nebivolol alone (p < 0.01). Diastolic blood pressure (p < 0.01), systolic blood pressure (p < 0.01), and heart rate (p < 0.01) were significantly lowered during treatment. Moreover, nebivolol treatment (alone or in combination with other antihypertensives) statistically significantly improved libido, breathlessness, and energy level (p < 0.05). Conclusion: The favourable effect on peak respiratory flow, coupled with an improved quality of life, renders this cardioselective β1-blocker useful in the treatment of essential hypertension in the general practice setting.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"103 - 108"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65222102","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":"AMI – ‘Acquired Microbe Invasion’?","authors":"C. Jespersen","doi":"10.1159/000077706","DOIUrl":"https://doi.org/10.1159/000077706","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"101 - 102"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65221377","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":"Influenza and Pneumococcal Vaccinations Fail to Prevent Myocardial Infarction","authors":"D. Meyers, D. D. Beahm, P. D. Jurisich, C. J. Milford, S. Edlavich","doi":"10.1159/000077705","DOIUrl":"https://doi.org/10.1159/000077705","url":null,"abstract":"Background: Four observational studies and one clinical trial have suggested that influenza vaccination is associated with a >50% reduction in risk of cardiac sudden death, myocardial infarction (MI), and stroke. One observational study found no effect. Objective: To identify an association between influenza or pneumococcal vaccination and myocardial infarction. Methods: We conducted a case-control study of discharges from nine metropolitan hospitals to identify a possible association between both influenza and pneumococcal vaccinations and MI, using patients with bone fractures as controls. We administered a standardized questionnaire to 335 MI patients and 199 patients with fractures (76% of eligible patients). Results: The groups significantly differed by sex, age, body mass index, smoking status, family history of heart disease, personal history of cardiovascular disease, and number of self-reported upper respiratory infections both during the winter months of interest and in the two weeks prior to their index event. Influenza vaccine had been administered to 177 (53%) MI patients and 126 (63%) fracture patients (p = 0.049) with an adjusted odds ratio (OR) = 0.90 (95% confidence interval 0.60, 1.35), p = 0.593. In 148 pairs matched by age and sex, the post hoc adjusted OR = 0.97. Pneumococcal vaccine had been administered to 107 (32%) MI patients and 78 (39%) fracture patients (p = 0.203) with an adjusted OR = 0.89 (95% confidence interval 0.60, 1.33), p = 0.577, and a power = 0.96 to detect a difference ≧40%. Conclusions: Neither influenza nor pneumococcal vaccine is associated with a reduced risk of myocardial infarction. A randomized controlled trial is needed.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"96 - 100"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65220638","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":"Prognostic Value of INR Fluctuations during Anticoagulant Therapy in Patients with Atrial Fibrillation and a High Thromboembolic Risk","authors":"P. Sanchez‐Pena, A. Bouzamondo, P. Lechat","doi":"10.1159/000077010","DOIUrl":"https://doi.org/10.1159/000077010","url":null,"abstract":"Background: Anticoagulation therapy with vitamin K agents needs regular monitoring to maintain the International Normalized Ratio (INR) within the recommended target range (2–3) for an appropriate benefit to risk ratio in patients with atrial fibrillation. Still, INR fluctuates greatly with time, even with the same dose for a given patient. Objective: The purpose of our analysis was to try to identify the possible factors participating in INR fluctuations and to study whether INR instability affects the occurrence of thromboembolic and hemorrhagic events in clinical practice. Methods: We studied INR data of 157 patients participating in a prospective anticoagulant (fluindione) and aspirin association in patients with high-risk atrial fibrillation trial [Fluindione, Fibrillation Auriculaire, Aspirin et Contraste Spontane (FFAACS) study]. During the first year of follow-up, INR variability was assessed by four different parameters. Logistic regression models were performed to assess the predictive power of INR variability recorded during the first year and its relationship with the occurrence of thromboem bolic and bleeding events during the 5 years of follow- up. Results: No clinical or biological parameter studied was significantly associated with INR variability in this population. No INR variability parameter was significantly predictive of thromboembolic events. In contrast, patients with greater difference between the maximal and the minimal registered INR values and INR variability over time had a significantly higher incidence of any hemorrhagic complication (odds ratios of 2.6 and 1.9, respectively) during follow-up. Conclusions: Large fluctuations of the INR are an important factor to take into account for the bleeding risk in patients with atrial fibrillation with a high thromboembolic risk receiving oral anticoagulation therapy.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"80 - 86"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65218530","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":"Congress Calendar","authors":"","doi":"10.1159/000078418","DOIUrl":"https://doi.org/10.1159/000078418","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"109 - 110"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65226499","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":"Variability in Cytochrome P450-Mediated Metabolism of Cardiovascular Drugs: Clinical Implications and Practical Attempts to Avoid Potential Problems","authors":"E. Molden","doi":"10.1159/000076934","DOIUrl":"https://doi.org/10.1159/000076934","url":null,"abstract":"Cytochrome P450 (CYP) enzymes play an important role in the turnover of more than 50 cardiovascular drugs (CVDs). Variable CYP activities due to genetic polymorphism or drug interactions are important sources of variability in systemic exposure of many of these drugs. The therapeutic implications are in most cases an increased response (effect/side effects) in patients with genetically determined decreased/deficient metabolic activity or during concurrent use of CYP inhibitors. Special attention with regard to safety should be paid to several coumarin-type anticoagulants, antiarrhythmics, β-receptor antagonists and HMG-CoA reductase inhibitors (statins). Prevention of potential clinical problems associated with CYP variability is easily achieved using equally effective therapeutic alternatives that are not dependent on CYP metabolism. However, if ‘CYP sensitive’ CVDs are either the preferred or only therapeutic alternatives, restrictive use of inhibitors is advisable, whereas patient genotyping prior to treatment might be a helpful tool to apply rational (individual) doses for certain agents.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"55 - 79"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000076934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65216552","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":"Effect of N-Acetylcysteine on Serum Creatinine Concentration in Patients with Chronic Renal Insufficiency Who Are Undergoing Coronary Angiography","authors":"M. Agrawal, Anna M. Wodlinger, Chad E. Huggins, G. Tudor, J. Pieper, K. O’Reilly, Cynthia J. Denu-Ciocca, G. Stouffer, E. Ohman","doi":"10.1159/000077294","DOIUrl":"https://doi.org/10.1159/000077294","url":null,"abstract":"Background: Prior studies have produced conflicting results on whether N-acetylcysteine (NAC) reduces the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CA). The dosing regimens of NAC in these studies seemed impractical for everyday clinical practice. Objective:We studied the effect of NAC, with a novel dosing strategy, on serum creatinine concentration (SCr), and the incidence of CIN, in patients who were undergoing CA and/or percutaneous coronary intervention (PCI). Methods: Twenty-five subjects with baseline renal insufficiency who were undergoing CA and/or PCI were randomized to either NAC or placebo.The treatment schedule was 800 mg of NAC 12 h prior to angiography, 600 mg of NAC 2 h prior to angiography, and 600 mg of NAC 6 h after angiography or matching placebo. All subjects were hydrated with 1 ml/kg of 0.45% saline and received non-ionic contrast for angiography. The primary endpoint was change in SCr and the secondary endpoint was the incidence of CIN as defined by an increase of 0.5 mg/dl or 25% in SCr at 48 h. Results:The average SCr at enrollment was 1.7 mg/dl and average dye exposure was 171 ml. The average change in SCr in the NAC and placebo groups was 0.14 and 0.06 mg/dl, respectively (p = 0.60). The incidence of CIN was 18 and 14% in the NAC and placebo groups, respectively (p = 1.0). Conclusion: In this small study, there was no significant difference in the change inSCr nor the incidence of CIN in patients with baseline renal insufficiency undergoing CA and/or PCI who were treated with NAC or placebo.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"87 - 91"},"PeriodicalIF":0.0,"publicationDate":"2004-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000077294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65219666","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":"2003 European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension","authors":"S. Kjeldsen","doi":"10.1159/000076262","DOIUrl":"https://doi.org/10.1159/000076262","url":null,"abstract":"Accessible online at: www.karger.com/hed S.E.K. is a member of the Council of the European Society of Hypertension and of the Writing Group of the 2003 European Society of Hypertension-European Society of Cardiology Guidelines. Hypertension, hypercholesterolemia and smoking are the most important risk factors for cardiovascular disease and death. For the first time, the European sister organizations European Society of Hypertension (ESH) and European Society of Cardiology (ESC) have come out with joint guidelines regarding the detection and treatment of hypertension – printed in this special issue of Heart Drug. It is realized that cardiologists play a key role more than ever in the care of hypertensive patients and an increasingly important role as educators in this field. The Guidelines Paper was developed by experts in the cardiovascular field and key opinion leaders from most countries in Europe. The guidelines are based on the 1999 International Society of Hypertension/World Health Organization Guidelines and they are endorsed by the International Society of Hypertension. It is a thorough educational document with more than 300 quotations of important publications. The new guidelines integrate detection and treatment of other important risk factors, including diabetes. A new issue in the risk assessment of hypertensive patients and for the first time included in the guidelines is the detection of target organ damage like left ventricular hypertrophy, arterial plaque, microalbuminuria or slightly elevated serum creatinine. With a 10-year risk of cardiovascular disease of 20% or more, drug treatment for hypertension is always warranted, and a statin and acetylsalicylic acid would usually be indicated. In contrast to the 2003 American Guidelines (JNC-7), in these guidelines, a number of different drugs are considered evidence-based first-line treatment, and combination treatment is strongly recommended to reach blood pressure targets. A shortened ‘Practical Guidelines’ has been developed and will be translated into various European languages. It is expected that the 2003 ESH-ESC Guidelines will soon be implemented in all countries within the area of the European Union. Hopefully, these clinically oriented guidelines will provide the basis for improved hypertension care and control in Europe!","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"38 1","pages":"5 - 5"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65213037","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":"2003 European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension","authors":"","doi":"10.1159/000076263","DOIUrl":"https://doi.org/10.1159/000076263","url":null,"abstract":"Accessible online at: www.karger.com/hed S.E.K. is a member of the Council of the European Society of Hypertension and of the Writing Group of the 2003 European Society of Hypertension-European Society of Cardiology Guidelines. Hypertension, hypercholesterolemia and smoking are the most important risk factors for cardiovascular disease and death. For the first time, the European sister organizations European Society of Hypertension (ESH) and European Society of Cardiology (ESC) have come out with joint guidelines regarding the detection and treatment of hypertension – printed in this special issue of Heart Drug. It is realized that cardiologists play a key role more than ever in the care of hypertensive patients and an increasingly important role as educators in this field. The Guidelines Paper was developed by experts in the cardiovascular field and key opinion leaders from most countries in Europe. The guidelines are based on the 1999 International Society of Hypertension/World Health Organization Guidelines and they are endorsed by the International Society of Hypertension. It is a thorough educational document with more than 300 quotations of important publications. The new guidelines integrate detection and treatment of other important risk factors, including diabetes. A new issue in the risk assessment of hypertensive patients and for the first time included in the guidelines is the detection of target organ damage like left ventricular hypertrophy, arterial plaque, microalbuminuria or slightly elevated serum creatinine. With a 10-year risk of cardiovascular disease of 20% or more, drug treatment for hypertension is always warranted, and a statin and acetylsalicylic acid would usually be indicated. In contrast to the 2003 American Guidelines (JNC-7), in these guidelines, a number of different drugs are considered evidence-based first-line treatment, and combination treatment is strongly recommended to reach blood pressure targets. A shortened ‘Practical Guidelines’ has been developed and will be translated into various European languages. It is expected that the 2003 ESH-ESC Guidelines will soon be implemented in all countries within the area of the European Union. Hopefully, these clinically oriented guidelines will provide the basis for improved hypertension care and control in Europe!","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"6 - 51"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000076263","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65213421","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}