The Canadian journal of cardiology
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A number of placebo-controlled randomized clinical trials have clearly established that blood pressure (BP) lowering, based on all antihypertensive drugs studied, lowers the risk of all major BP-related cardiovascular events. However, this does not exclude that some antihypertensive agents are more or less effective in preventing cardiovascular events than to be expected from the extent of BP lowering. Indeed, clinical trials of thiazide diuretics using 'high' doses demonstrated marked prevention of strokes, but little to no prevention of coronary events. ⋯ However, placebo-controlled trials, such as HOPE and, recently, the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA), are confounded by the difference in BP and its impact on outcome. Indeed, as a mirror image of these trials, the blacks subgroup in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) exhibited a 4 to 5 mmHg higher systolic BP on ACE inhibitor as compared with the diuretic, associated with 19% higher combined cardiovascular disease and 40% higher stroke rate. Recent overviews of randomized clinical trials comparing outcomes with different antihypertensive drug classes concluded that outcome benefits beyond BP lowering remain unproven.
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Multicenter Study Comparative Study
Impact of guidelines on health care use for the management of dyslipidemia in two Canadian provinces, Alberta and Nova Scotia, from 1990 to 2001.
Guidelines for the treatment of hyperlipidemia aim at improving the management of people at a higher risk of developing cardiovascular disease. ⋯ Despite some limitations, these data show a discrepancy between guideline development and practice, leaving a high number of at-risk individuals undiagnosed and untreated. Mechanisms need to be put in place to ensure better classification and follow-up of people with hyperlipidemia at risk for cardiovascular disease.
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Comparative Study
Prediction of in-hospital mortality by brain natriuretic peptide levels and other independent variables in acutely ill patients with suspected heart disease.
Brain natriuretic peptide (BNP) measurement can detect and assess heart failure. However, compared with traditional clinical parameters, its value for predicting the in-hospital mortality of patients with suspected heart disease has not been reported. ⋯ Five independent variables (hypotension, anemia, leukocytosis, prior illness and elevated BNP levels) are comparable predictors of in-hospital mortality in patients with suspected heart disease.
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The use of ventricular assist devices as a 'bridge to recovery' has a lot to promise. However, we are at a stage where there are more questions than answers. It is still difficult to predict who will be the right candidate and who will have sustained recovery after explantation of the device. ⋯ A case that was successfully bridged to recovery with a left ventricular assist device is presented, together with a discussion of the literature. The search for precise markers of recovery should continue and a multicentre prospective study to validate weaning protocols is needed. At present, one should consider all available markers and look at the full clinical picture before allocating a patient to a bridge to recovery destination.