Mayo Clinic proceedings
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Mayo Clinic proceedings · Jan 2009
Comparative StudyEffect of second-generation sulfonylureas on survival in patients with diabetes mellitus after myocardial infarction.
To examine possible adverse effects of sulfonylureas on survival among patients with diabetes mellitus (DM) who experience a myocardial infarction (MI). ⋯ These population-based data do not support the concern about an adverse effect of second-generation sulfonylureas on survival after MI and underscore the importance of population-based studies of surveillance of drug safety.
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Mayo Clinic proceedings · Jan 2009
ReviewSubclinical hypothyroidism: an update for primary care physicians.
Subclinical hypothyroidism (SCH), also called mild thyroid failure, is diagnosed when peripheral thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. This condition occurs in 3% to 8% of the general population. It is more common in women than men, and its prevalence increases with age. ⋯ The possibility that it is a cardiovascular risk factor has been a subject of debate. Large-scale randomized studies are needed for evidence-based recommendations regarding screening for mild thyroid failure and levothyroxine therapy for this condition. Currently, the practical approach is routine levothyroxine therapy for persons with a persistent serum TSH of more than 10.0 mIU/L and individualized therapy for those with a TSH of less than 10.0 mIU/L.
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Mayo Clinic proceedings · Jan 2009
ReviewSecondary prevention of atherothrombotic events after ischemic stroke.
Atherosclerotic vascular disease is the leading cause of ischemic stroke, resulting in occlusive or severely stenotic lesions of major intracranial or extracranial arteries and narrowing of small penetrating arteries of the brain. Atherosclerosis of the coronary arteries (ie, coronary artery disease) is an indirect cause of cardioembolic stroke secondary to myocardial infarction. ⋯ Prevention of recurrent stroke involves controlling those factors that promote the course of atherosclerosis, including hypertension, hyperlipidemia, diabetes mellitus, and smoking, as well as such local interventions as carotid endarterectomy and endovascular treatment. Nevertheless, administration of antiplatelet agents remains the core of management for preventing recurrent stroke and other cardiovascular events in at-risk patients.
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Mayo Clinic proceedings · Jan 2009
ReviewPerioperative cardiovascular assessment of patients undergoing noncardiac surgery.
Preoperative assessment of the cardiac patient before noncardiac surgery is common in the clinical practice of the medical consultant, anesthesiologist, and surgeon. Currently, most noncardiac surgical procedures are performed for patients of advanced age, and the number of such surgeries is likely to increase with the aging of the population. These same patients have an increased prevalence of cardiovascular disease, especially ischemic heart disease, which is the primary cause of perioperative morbidity and mortality associated with noncardiac surgery. ⋯ Our review describes the 2007 American College of Cardiology/American Heart Association guidelines, the most recent revision, focusing on a newly recommended 5-step algorithmic approach to managing this clinical problem, particularly for the patient with known or suspected coronary heart disease. Continued emphasis should be given to preoperative clinical risk stratification, with noninvasive testing reserved for those patients in whom a substantial change in medical management would be anticipated based on results of testing. Pharmacologic therapy holds more promise than coronary revascularization for the reduction of major adverse perioperative cardiac events that might complicate noncardiac surgery.
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Mayo Clinic proceedings · Jan 2009
Comparative StudyCongenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy.
To determine the risk of congenital cardiac abnormalities associated with use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. ⋯ Our data are reassuring regarding the safety of using SSRIs during pregnancy.