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Old August 12th, 2002, 20:10
sysadmin sysadmin is offline
Join Date: 2001
Posts: 1,085
July 2002

Wednesday, July 31, 2002

Aerobic Fitness Associated With Lower C-Reactive Protein Levels
This study of 135 women found that those who were fit had lower c-reactive protein levels. The authors conclude that exercise may have an antiinflammatory mechanism. Comment: this may explain in part why it has been shown that patients with fibromyalgia benefit from aerobic exercise. [ article ]  

Tuesday, July 30, 2002

Beta-Blocker Therapy Not Associated With Depression
This meta-analysis found that beta-blocker therapy did not increase depression. Beta blockers were found to increase fatigue very slightly- the equivalent of 1 additional patient reporting fatigue for every 57 patients treated. The association with sexual dysfunction was also small, with the equivalent of 1 additional patient reporting sexual dysfunction for every 199 patients treated per year. Early generation beta blockers were found to be more likely to cause fatigue. [ article ]  

Monday, July 29, 2002

Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
This prospective study of 1586 patients presenting to the emergency department with shortness of breath found that measuring bedside b-type natriuretic peptide was helpful in making a prompt diagnosis of congestive heart failure. The diagnostic accuracy using a cutoff of 100 pg/ml was 83.4%.  

Monday, July 22, 2002

Atorvastatin Found to Lower C-Reactive Protein
In patients with acute coronary syndromes, atorvastatin, 80 mg, was found to lower c-reactive protein levels. Comment: statins are showing more and more promise in patients with *acute* coronary syndromes. [ACC 2002 Annual Scientific Sessions, abstract 815-2 as reported in Patient Care, June 2002 p9.]  


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Sunday, July 21, 2002

Niacin / Lovastatin Combination More Effective Than Statin Alone
The extended release combination pill of niacin combined with lovastatin was more effective than either atorvastatin or simvastatin in managing lipid disorders. Of note, the combination was found to be safe and well tolerated. [ ACC 2002 Annual Scientific Sessions abstract 833-5, as reported in Patient Care, June 2002]  

Friday, July 19, 2002

The PROGRESS and HOPE Trials: ACE Inibitors Beneficial in Preventing Vascular Events
This is an excellent review article on the findings of the recent PROGRESS and HOPE trials. Both studies found a significant reduction in cardiovascular events in those taking an ace-inhibitor. HOPE used ramipril and PROGRESS used perindopril. Comment: it looks like there will soon be new recommendations for doctors in the first-line treatment of hypertension. Beta blockers and diuretics have been recommended as first-line treatments for a long time. These studies may put ace inhibitors at the top of the list of first-line therapies for high blood pressure. [ article ]  

Monday, July 15, 2002

Wine Better Than Beer in Reducing Cardiac Risks
This meta-analysis found more evidence supporting the risk-reduction effects of wine as compared to beer. Beer did also reduce vascular risk, but no significant relationship between amount of beer consumed and risk reduction was found. Comment: like it or not, it seems that the current evidence suggests that wine is better for your heart than beer. [ article ]  

Statins Negate Increased Cardiovascular Risk in Patients Taking Estrogen/Progestin Hormone Replacement
In this study of 2763 postmenopausal women with heart disease, it was shown that statin therapy lowered the risk of cardiovascular events, venous thromboembolic events, and total mortality. In those women not taking statins, the cardiac risk of hormone replacement therapy was higher than at baseline. If the woman also took a statin, then there was no increased risk. [ article ]  

Losartan Shown to Decrease Left Ventricular Mass
This three year study found that antihypertensive treatment with losartan decreased the left ventricular mass and improved other measurements of left ventricular functioning. [ article ]  


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AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update
The American Heart Association has updated its recommendations for preventing a first heart attack or stroke. Key new findings: screening should start at age 20, and consider starting a daily baby aspirin if the estimated 10 year risk of heart disease is greater than or equal to 10%. Emphasis is placed on smoking cessation and avoidance of 2nd hand smoke as well as weight. A BMI of 18.5 to 24.9 is recommended. If above that, the waist circumference just above the superior iliac crest should be less than 40 inches for men, and less than 35 inches for women. Comment: this is an important update. [ article ]  

Church Attendence Linked to Lower C-Reactive Protein Levels in Diabetics
This study of 556 diabetics found that church attendence at least once a year was associated with a lower level of c-reactive protein (a marker for heart disease). The researchers note that they only measured church attendence, not how religious the person was. Non-diabetics were not found to have any association between church attendence and c-reactive protein levels. Comment: this study looks like data mining. That is, if you look at enough combinations of data, the chances are excellent that at least one combination will come up "statistically significant." Thus, the validity of this study is highly questionable. There is other, much stronger evidence that morality is linked to good health. This study does not provide anything more than an interesting idea. [ article ]  

Saturday, July 13, 2002

Can flossing teeth foil heart disease?
There continues to be more interest into the connection between dental health and cardiac disease. The hypothesis is that when people chew, a bacteremia is created which causes systemic effects. Comment: dental health has also been linked to a decrease in pneumonia in nursing home patients. [ article ]  

Coumadin Superior to Aspirin After Acute Coronary Events
This study of 999 patients who recently suffered an acute coronary event found that aspirin was not as effective as either coumadin alone or a combination of coumadin and aspirin. The researchers looked at the rate of subsequent myocardial infarction, stroke or death in the three groups. The aspirin group had an event rate of 9% versus 5% for the coumadin only group, and 5% for the coumadin/aspirin group. [ article ]  

Wednesday, July 10, 2002

Children Should Be Screened for Heart Disease
Recent recommendations from the American Heart Association as published in their journal Circulation make recommendations to aggressively screen children for coronary artery disease. As reported in the BMJ, the recommendations are that the blood pressure should be measured from age 3, and cholesterol starting at 5 years of age. Also recommended by several papers in the journal Pediatrics is that childhood obesity needs to be vigorously addressed. Both obesity and the early development of coronary artery disease are becoming serious problems globally. [ article ]  


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Sunday, July 07, 2002

Screening Children For Coronary Artery Disease
This statement on cardiovascular health in childhood from the American Heart Association lists several ways parents and primary care doctors can help treat and prevent the growing epidemic of childhood obesity. The article lists several indications for screening young children for high cholesterol. One of the strategies the article recommends is for parents to not reward their children by taking them to a fast-food joint. Parents should emphasize physical play, not exercise. Children should eat a standard low-fat diet that is rich in fruits, vegetables, and fiber. Comment: this is an excellent article that parents should read. [ article ]  

Routine Hormone Replacement Therapy Not Recommended
This study from JAMA found that hormone replacement therapy carries significant risks among post-menopausal women. The authors recommend against routine hormone replacement therapy. [ article ]  

Statins Helpful Even When Cholesterol Levels are Normal
This study of 20 356 adults with coronary disease, occlusive arterial disease, or diabetes found a positive association between statin use (40 mg per day of simvastatin) and all-cause mortality. Comment: the benefits were present even in the volunteers with a low LDL cholesterol level at entry into the study. [ article ]  

Saturday, July 06, 2002

A Surprising Cure for Heart Failure
In this article, a general practitioner describes how he was able to succeed in curing a patient with NYHA class IV heart failure, whereas several cardiologists failed even after an angiogram, several echocardiograms and EKG's. [ article ]  

Unstable Angina Associated With Widespread Inflammation
This study looked at the neutrophil myeloperoxidase content in cardiac and femoral circulations in a total of 65 patients. It found that the patients with unstable angina had depleted neutrophil myeloperoxidase, indication neutrophil activation. The authors conclude that widespread neutrophil activation may be the primary cause of unstable angina. This goes against the prevailing hypothesis that unstable angina is due to a single vulnerable plaque. Comment: it's possible that the anti-inflammatory effect of aspirin is just as important as its anti-platelet effect. [ article ]  
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