Postgraduate medicine
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People with diabetes are more likely to develop a cardiovascular (CV) disease compared with those without diabetes. Although effective glycemic control has been the focus of the management of type 2 diabetes mellitus (T2DM), it is also important to control other CV risk factors to improve outcomes in these patients. Dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, lowers glucose levels in patients with T2DM by increasing urinary glucose excretion. ⋯ Furthermore, a lower rate of cardiac events was seen in patients taking dapagliflozin compared with those taking comparators in a meta-analysis of clinical trials on dapagliflozin. Overall, dapagliflozin has shown beneficial effects on CV risk factors in patients with T2DM. Further studies are underway to evaluate the effect of dapagliflozin on CV outcomes.
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Postgraduate medicine · May 2013
ReviewStroke prevention in patients with atrial fibrillation: focus on new oral anticoagulants.
Patients with atrial fibrillation are at an increased risk for stroke. Anticoagulation therapy has been shown to significantly reduce the risk for stroke in these patients. Warfarin therapy is effective at reducing the risk for thromboembolic events, but requires frequent monitoring of its anticoagulation effect using the international normalized ratio and significantly increases the risk for hemorrhagic events, including intracranial hemorrhage. ⋯ These drugs include dabigatran (a direct thrombin inhibitor) as well as rivaroxaban and apixaban (factor Xa inhibitors). The new anticoagulants have rapid onset of effect; their anticoagulatory effect is stable, predictable, and dose related; and they do not require monitoring of anticoagulation effect using the international normalized ratio. The pharmacology, clinical efficacy, and potential adverse effects of these drugs in patients with atrial fibrillation are reviewed herein.
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Postgraduate medicine · May 2013
ReviewReview of insulin-dependent and insulin-independent agents for treating patients with type 2 diabetes mellitus and potential role for sodium-glucose co-transporter 2 inhibitors.
Diabetes, especially type 2 diabetes mellitus (T2DM), continues to be a global health care problem. Although the beneficial effects of glycemic control are well established, in the United States, > 40% of adults with diabetes fail to achieve target glycated hemoglobin levels. Antidiabetic drug classes vary with respect to their mechanisms of action, glucose-lowering potential, and safety and tolerability profiles. ⋯ In clinical trials, these agents have been shown to improve glycemic control and to reduce body weight in patients with T2DM. Additionally, SGLT2 inhibitors pose a low risk for hypoglycemia and are generally well tolerated; however, their use has been associated with an increase in the frequency of genital infections and, in some studies, urinary tract infections. Sodium-glucose co-transporter 2 inhibitors may provide an alternative or an addition to existing therapies for the treatment of patients with T2DM.
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Postgraduate medicine · Mar 2013
Clinical Trial12-month observation of testosterone replacement effectiveness in a general population of men.
Testosterone decline becomes more prevalent as men age and symptomatic testosterone deficiency is associated with potentially serious comorbidities. Despite limitations, registries can provide an opportunity to accumulate data regarding disease management in a typical patient population, including diagnosis, treatment, and outcomes. ⋯ Testosterone deficiency symptoms improved with TRT use in men; sexual function and mood/depression improvements were seen before metabolic improvements. Prostate-specific antigen levels increased, although increases were within guideline-determined safety limits.
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Postgraduate medicine · Mar 2013
ReviewCarotid intima-media thickness testing as an asymptomatic cardiovascular disease identifier and method for making therapeutic decisions.
Cardiovascular disease (CVD) is the leading cause of death and disability in the United States. Although current therapies can reduce the risk for CVD, they are only given to patients who are considered to be at risk, and are therefore only beneficial if a patient's risk is accurately predicted before he or she sustains a cardiovascular (CV) event. Unfortunately, even relatively accurate risk factor analyses, such as the Reynolds Risk Score algorithm, fail to identify some patients who will sustain a CV event within 10 years. ⋯ To date, several trials have provided evidence to indicate that some CVD therapies slow, stop, or reverse the progression of CIMT. Although many of these studies show that changes in CIMT predict future CV events, the value of CIMT testing in CVD risk assessment is still vigorously debated. In this article, we clarify the utility of CIMT testing for risk classification and reexamine its usefulness as a method for assessing therapeutic efficacy.