American heart journal
-
American heart journal · Feb 2006
ReviewAre statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention.
The relative efficacy of different statins for long-term cardiovascular prevention remains largely undetermined. ⋯ Evidence from published statin randomized placebo-controlled trials suggests that pravastatin, simvastatin, and atorvastatin, when used at their standard dosages, show no statistically significant difference in their effect on long-term cardiovascular prevention.
-
American heart journal · Feb 2006
ReviewHomocysteine-lowering trials for prevention of cardiovascular events: a review of the design and power of the large randomized trials.
Dietary supplementation with folic acid and vitamin B12 lowers blood homocysteine concentrations by about 25% to 30% in populations without routine folic acid fortification of food and by about 10% to 15% in populations with such fortification. In observational studies, 25% lower homocysteine has been associated with about 10% less coronary heart disease (CHD) and about 20% less stroke. ⋯ The strength of association of homocysteine with risk of cardiovascular disease may be weaker than had previously been believed. Extending the duration of treatment in these trials would allow any effects associated with prolonged differences in homocysteine concentrations to emerge. Establishing a prospective meta-analysis of the ongoing trials of homocysteine lowering should ensure that reliable information emerges about the effects of such interventions on cardiovascular disease outcomes.
-
American heart journal · Feb 2006
Randomized Controlled TrialUse of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease.
In patients with pulmonary disease, it is often challenging to distinguish exacerbated pulmonary disease from congestive heart failure (CHF). The impact of B-type natriuretic peptide (BNP) measurements on the management of patients with pulmonary disease and acute dyspnea remains to be defined. ⋯ CHF is a major cause of acute dyspnea in patients with a history of pulmonary disease. Used in conjunction with other clinical information, rapid measurement of BNP reduced time to discharge and total treatment cost of these patients.
-
American heart journal · Feb 2006
Multicenter StudyEpidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: a national survey. The Endocarditis Infecciosa en la República Argentina-2 (EIRA-2) Study.
This study aimed to determine the epidemiologic, clinical, microbiologic characteristics, and inhospital outcome of infective endocarditis (IE) in Argentina and compare the results with those of the 1992 IE national survey. ⋯ The EIRA-2 survey shows that the clinical profile of IE has changed in Argentina. Currently, patients with IE are older and have a higher frequency of underlying heart disease, degenerative valve disease, and prosthetic valve IE than previously. The incidence of staphylococcal IE has increased. Inhospital mortality remains high, suggesting that more aggressive measures are needed for the early identification, prevention, and treatment of IE.
-
American heart journal · Feb 2006
Subgroup analyses in therapeutic cardiovascular clinical trials: are most of them misleading?
Treatment decisions in clinical cardiology are directed by results from randomized clinical trials (RCTs). We studied the appropriateness of the use and interpretation of subgroup analysis in current therapeutic cardiovascular RCTs. ⋯ Subgroup analyses in recent cardiovascular RCTs were reported with several shortcomings, including a lack of prespecification and testing of a large number of subgroups without the use of the statistically appropriate test for interaction. Reporting of subgroup analysis needs to be substantially improved because emphasis on these secondary results may mislead treatment decisions.