Current medical research and opinion
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Administration of high intensity statins prior to percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease has been shown to reduce short-, mid-, and long-term cardiovascular disease (CVD) morbidity and mortality as well as overall mortality compared with lower intensity statins or no statin treatment. The mechanisms involved are probably related to the pleiotropic effects of statins. ⋯ A decreased risk of contrast-induced nephropathy (CIN) post-PCI might be an extracardiac mechanism that contributes to the reduction in all cause and CVD mortality. These results support the need for the administration of statins before PCI.
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Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity, mortality, and healthcare expenditure. Anticoagulant therapy is recommended for at least 3 months in patients with acute VTE to prevent recurrence. Conventional anticoagulants are associated with inherent limitations including route of administration, required monitoring and dose adjustments, potential for food-drug and drug-drug interactions, unpredictable pharmacokinetics and pharmacodynamics, and possible severe adverse events. ⋯ NOACs offer additional oral anticoagulation treatment options for patients with VTE.
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Comparative Study Observational Study
How effective are the ESC/EAS and 2013 ACC/AHA guidelines in treating dyslipidemia? Lessons from a lipid clinic.
There is a paucity of data regarding the attainment of lipid-lowering treatment goals according to the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The aim of the present study was to assess how applicable these 2013 recommendations are in the setting of an Outpatient University Hospital Lipid Clinic. ⋯ The application of the ACC/AHA guidelines may be associated with undertreatment of high risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA.
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Guideline panels recognize the need to increase the accuracy of identifying women at high risk of developing breast cancer who would benefit from prevention strategies. The characterization of proliferative epithelial disease found in nipple aspirate fluid (PED-NAF) may be a relevant risk factor. ⋯ PED-NAF among women free of breast cancer, compared with no fluid being obtained, has an independent risk of developing breast cancer comparable to the risk of a woman with a positive family history of breast cancer. These findings have implications for augmenting risk prediction and clinical decisions concerning breast cancer surveillance and chemoprevention. As with all reviews, heterogeneity across studies may have influenced the results. The limited literature calls for prospective studies on asymptomatic women with long-term follow-up.
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To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding associated emergency department (ED) visits in the US. ⋯ Our results indicate that there has been an increasing incidence of GI bleeding associated ED visits in children from 2006 to 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the US.