American heart journal
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American heart journal · Dec 2007
Multicenter StudyOptimal medical therapy at discharge in patients with acute coronary syndromes: temporal changes, characteristics, and 1-year outcome.
There are limited data on the recent trend in the use of optimal evidence-based medical therapies after acute coronary syndromes (ACSs). We sought to evaluate (1) the temporal changes in medical management of patients discharged after an ACS; (2) patient and practice characteristics associated with optimal medical therapy at discharge; and (3) the association between discharge medication use and 1-year outcome. ⋯ Despite the temporal increases in the combined use of evidence-based pharmacologic therapies, which is associated with improved outcome, medical management of ACS remains suboptimal. Quality improvement strategies are needed to enhance the appropriate use of effective therapies, targeting specifically the high-risk but undertreated patients who may derive the greatest therapeutic benefit.
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American heart journal · Dec 2007
ReviewHow to prevent perioperative myocardial injury: the conundrum continues.
Perioperative myocardial injury (PMI) remains a major cause of perioperative morbidity and mortality but clinical strategies to prevent PMI are still uncertain. ⋯ Further studies, especially randomized clinical trials and mechanistic investigation are needed to find the best and effective clinical strategies to prevent/reduce PMI.
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American heart journal · Dec 2007
The effect of leisure-time physical activity on the presence of metabolic syndrome in patients with manifest arterial disease. The SMART study.
Physical activity can influence insulin sensitivity and metabolic syndrome (MetS) independent of weight loss. Therefore, we investigated the independent effect of leisure-time physical activity on the prevalence of MetS and insulin resistance in patients with manifest arterial disease and the role of body fat and fat distribution on this relationship. ⋯ Patients with manifest arterial disease who are physically active are less likely to have MetS and insulin resistance than physically inactive patients, although body weight is comparable between the groups.
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American heart journal · Nov 2007
Statin therapy is associated with improved outcomes in vascular surgery patients with renal impairment.
Little is known about the association between baseline kidney function, statin therapy, and outcome after vascular surgery in patients with and without chronic kidney disease. ⋯ The level of kidney function is an independent predictor of short- and long-term outcome after major noncardiac surgery. In addition, perioperative statin use in patients with kidney disease is associated with a reduction in the short- and long-term all-cause, cardiac, and cerebrocardiovascular mortality.
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American heart journal · Oct 2007
Randomized Controlled Trial Comparative StudyRationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome.
Cardiovascular disease, including aortic root dilation, dissection, and rupture, is the leading cause of mortality in patients with Marfan syndrome (MFS). The maximal aortic root diameter at the sinuses of Valsalva is considered the best predictor of adverse cardiovascular outcome. Although advances in therapy have improved life expectancy, affected individuals continue to suffer cardiovascular morbidity and mortality. Recent studies in an FBN1-targeted mouse model of MFS with aortic disease similar to that seen in humans showed that treatment with losartan normalized aortic root growth and aortic wall architecture. ⋯ This randomized trial should make a substantial contribution to the management of individuals with MFS and expand our understanding of the mechanisms responsible for the aortic manifestations of this disorder.