The American journal of medicine
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Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk. ⋯ Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.
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Despite their proven mortality and morbidity outcomes benefits, beta-blockers remain substantially underused in patients with cardiac conditions. Reluctance to prescribe beta-blockers may be owing to concerns about tolerability with the traditional drugs in this class. Beta-blockers with vasodilatory properties, such as carvedilol and nebivolol, may overcome the tolerability and metabolic issues associated with traditional beta-blockers. Because endothelial dysfunction, the pathophysiologic hallmark of hypertension, may be heightened in populations with difficult-to-treat hypertension (e.g., elderly patients, African American patients), a vasodilating beta-blocker may be a particularly appropriate choice for these patient groups.
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Atrial fibrillation is associated with substantial mortality and morbidity from stroke and thromboembolism. Despite an efficacious oral anticoagulation therapy (warfarin), atrial fibrillation patients at high risk for stroke are often under-treated. This systematic review compares current treatment practices for stroke prevention in atrial fibrillation with published guidelines. ⋯ This systematic review demonstrates the underuse of oral anticoagulation therapy for real-world atrial fibrillation patients with an elevated risk of stroke, highlighting the need for improved therapies for stroke prevention in atrial fibrillation.
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Multicenter Study
Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox.
Obese patients have favorable outcomes in congestive heart failure, hypertension, peripheral vascular disease, and coronary artery disease. Obesity also has been linked with increased incidence of atrial fibrillation, but its influence on outcomes in atrial fibrillation patients has not been investigated. The objective of this research is to investigate the effect of obesity on outcomes in atrial fibrillation. ⋯ Although in prior studies, obesity has been associated with increased risk of atrial fibrillation, an obesity paradox exists for outcomes in atrial fibrillation. Obese patients with atrial fibrillation appear to have better long-term outcomes than nonobese patients.
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Editorial Comment Review
A review of clinical guidelines with some thoughts about their utility and appropriate use.