Cardiology in review
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Cardiology in review · Jul 2009
ReviewImpact of glycemic treatment choices on cardiovascular complications in type 2 diabetes.
As the diabetic population has significant morbidity and mortality from cardiovascular disease (CVD), much of its medical care focuses on CVD prevention and treatment. Some medications used to treat hyperglycemia may have beneficial effects on CV outcomes, others may have negative effects, while still others seem to have no direct effect. Although past epidemiological studies have shown a relationship between glycated hemoglobin levels and CV events in patients with type 2 diabetes, recent large randomized clinical trials (ACCORD, ADVANCE, and VADT) lasting 3.5 to 5.6 years have found that intensive glycemic control either has no impact on CV outcomes or even worsens them. ⋯ There is an emerging notion that tight glycemic control may be beneficial in primary prevention of CVD in younger patients with diabetes, but may become deleterious in older patients with established or subclinical CVD. Thus, while tight control may lessen microvascular disease, it may increase the risk of hypoglycemia and possibly of adverse CV events. In each patient, the goals of glycemic control need to be individualized based on age, overall prognosis, presence of macrovascular disease, and risk of hypoglycemia.
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Cardiology in review · Jul 2009
ReviewCardiac manifestations of sarcoidosis and therapeutic options.
Sarcoidosis is a multisystem disorder of unknown etiology, characterized by granulomatous infiltration and the development of noncaseating granulomas in many organ systems. Although the lungs, eyes, and skin are most commonly affected, virtually any body organ can be involved. Clinical evidence of sarcoid heart disease (SHD) is seen only in 5% of patients and the disease may present with tachyarrhythmias, conduction disturbance, heart failure, or sudden cardiac death. ⋯ Various diagnostic tests such as the electrocardiogram, two-dimensional echocardiography, cardiac magnetic resonance imaging, positron emission tomography scan, radionuclide scan, and a transvenous endomyocardial biopsy are available for the early detection of cardiac involvement in sarcoidosis. Given that early diagnosis and treatment may prevent substantial morbidity and mortality in patients with cardiac involvement, it remains important to screen patients with sarcoidosis and initiate early treatment with corticosteroids. Other immunosuppressive agents, antiarrhythmic drugs, placement of an automated implantable cardiac defibrillator, or surgical options such as a pericardial window, ventricular aneurysm repair and cardiac transplant, may also be required for the management of patients with SHD.
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Cardiology in review · Jul 2009
ReviewDrug interaction between clopidogrel and proton pump inhibitors.
Dual antiplatelet therapy with clopidogrel and aspirin has been shown to reduce recurrent cardiac events in patients with acute coronary syndromes or those who have undergone coronary artery stent placement. Clopidogrel, a thienopyridine, is a prodrug that is transformed in vivo to an active metabolite by the cytochrome P450 enzyme system. ⋯ Data from recent studies show that PPIs, which are extensively metabolized by the cytochrome system, may decrease the antiplatelet activity of clopidogrel. This article reviews the metabolism of various PPIs and existing data regarding the drug-drug interaction between PPIs and clopidogrel.