The American journal of cardiology
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The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statin drugs, have been studied in numerous controlled human research trials involving hundreds of thousands of study participants. Statins have been prescribed for millions of patients. Based on this vast research and clinical experience, statins have been shown to improve lipid blood levels and reduce atherosclerotic coronary artery disease (CAD) risk, resulting in reduced CAD morbidity and mortality, and in several studies, reduced overall ("all-cause") mortality. ⋯ The evidence is at other times more speculative, being based on case reports and inconclusive clinical trial data (such as possible favorable or unfavorable effects of statins on cognition). Because the use of statins is so widespread, it is useful for the clinician to understand statin safety issues and the level of available evidence supporting the contention that various adverse effects are caused by statins. This review presents an assessment of statin safety based on an overview of the current statin safety data and their clinical implications.
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Comparative Study
Effect of pre-myocardial infarction angina pectoris on post-myocardial infarction arrhythmias after reperfusion therapy.
It has not been concluded whether there is a relation between pre-myocardial infarction angina pectoris (pre-MIAP) and reperfusion arrhythmia, although pre-MIAP has been reported to have a beneficial effect in preserving left ventricular function. Moreover, factors that are associated with reperfusion arrhythmias in patients with acute myocardial infarction (AMI) who have been successfully reperfused by reperfusion therapy are unknown. This study examined the predictive factors of reperfusion arrhythmias in patients with AMI who underwent successful reperfusion. ⋯ The odds ratio that predicted reperfusion arrhythmias was 2.37 (p = 0.0056) for inferior AMI. In contrast, the odds ratio was minimal at 0.24 for pre-MIAP (p = 0.036). In conclusion, pre-MIAP suppresses reperfusion arrhythmias, and inferior AMI is an independent factor for reperfusion arrhythmias.
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Heart failure (HF) is a major problem in the long-term follow-up of adults with congenital heart disease (CHD) after cardiac surgery. The purpose of this study was to evaluate risk factors for HF in patients with CHD. N-terminal-pro-brain natriuretic peptide and maximal oxygen uptake (VO2max) were measured in 345 consecutive patients with CHD. ⋯ Mean fractional shortening of the left ventricle was within the normal range. To estimate risk stratification, odds ratios for HF were determined for the most frequently occurring types of congenital heart defects and surgical procedures. In conclusion, HF in adults with CHD predominately depends on diagnosis, age, the frequency of reoperation, and right ventricular function and may be related to chronotropic incompetence indicated by lower maximal heart rates.
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Letter Biography Historical Article
Eisenhower's billion-dollar heart attack.
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B-type natriuretic peptide (BNP) is activated with mitral regurgitation (MR), but it is unclear whether BNP activation is uniform in organic and functional MR and whether it merely reflects symptoms or is a biomarker of left ventricular (LV) geometric and functional alterations. Comprehensive Doppler echocardiography and hormonal measurements were performed prospectively in 99 patients, 50 with organic MR, 28 with functional MR (with similar LV enlargement 130 +/- 21 vs 141 +/- 40, p = 0.18, and age 64 +/- 13 vs 66 +/- 12 years, p = 0.56) and 21 controls subjects of similar age. Compared with the controls, the patients with MR displayed LV remodeling and BNP activation. ⋯ With BNP >90 pg/ml, the odds ratio of an end-systolic volume index value of >/=60 ml/m(2) was 16 (95% confidence interval 5.5 to 45). In conclusion, BNP activation with MR is more pronounced in those with functional than those with organic MR, even after stratification for functional class, and independently reflects the severity of the LV alteration. Pronounced BNP activation is linked to a higher end-systolic volume index, for which it is a biomarker, irrespective of MR etiology and symptoms.