High-sensitivity cardiac troponin assay in predicting mortality?
Recent studies have shown that the high-sensitivity cardiac troponin assay can substantially improve early diagnosis of acute myocardial infarction and allow risk stratification of patients with stable congestive heart failure and acute coronary syndromes. An important recent study involving patients with stable coronary artery disease enrolled in the Prevention of Events with Angiotensin Converting Enzyme Inhibition Trial showed that elevated cardiac troponin T levels, measured with a high-sensitivity troponin assay, were significantly associated with the increased incidence of cardiovascular death. However, exclusion criteria consequent on the primary study design on angiotensin-converting enzyme inhibition produced a selected population that, among others, did not include patients who had a recent or planned revascularization procedure.
References:
1. Keller T., Zeller T., Peetz D., et al: Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361. 868-877.2009;
2 Reichlin T., Hochholzer W., Bassetti S., et al: Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361. 858-867.2009;
Wednesday, January 05, 2011
Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial
American Heart Journal - Volume 161, Issue 1 (January 2011)
In this study, despite weight gain, smoking cessation improved HDL-C, total HDL, and large HDL particles, especially in women. Smoking cessation did not affect LDL or LDL size. Increases in HDL may mediate part of the reduced cardiovascular disease risk observed after smoking cessation.
Each year, smoking contributes to >443,000 smoking-related deaths in the United States and few millions in the rest of the world; and nearly 20% of all coronary heart disease deaths can be attributed to smoking. Although the strong relationship between smoking and cardiovascular disease (CVD) has been well-documented, the mechanisms by which smoking increases CVD risk appear to be multifactorial and incompletely understood. Clinical trials, suggest that cigarette smoking is associated with a more atherogenic lipid profile characterized by higher total cholesterol and triglycerides (TG) with lower levels of high-density lipoprotein cholesterol (HDL-C).
References:
1 Center for Disease Control and Prevention : Smoking-attributable mortality, years of potential life lost, and productivity losses—United States. 2002-2004. [accessed 2009 Apr 8]Morb Mortal Wkly Rep 57. 1226-1228.2008;
2 American Heart Association : Heart disease and stroke statistics—2009 update. American Heart AssociationDallas (Tex)2009.
3 Doll R., Peto R., Boreham J., et al: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 328. 1519.2004;
4 Freund K.M., Belanger A.J., D'Agostino R.B., et al: The health risks of smoking. The Framingham Study: 34 years of follow-up. Ann Epidemiol 3. 417-424.1993;
5 Ambrose J.A., Barua R.S.: The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43. 1731-1737.2004;
6 Gossett L.K., Johnson H.M., Piper M.E., et al: Smoking intensity and lipoprotein abnormalities in active smokers. J Clin Lipidol 3. 372-378.2009;
American Heart Journal - Volume 161, Issue 1 (January 2011)
In this study, despite weight gain, smoking cessation improved HDL-C, total HDL, and large HDL particles, especially in women. Smoking cessation did not affect LDL or LDL size. Increases in HDL may mediate part of the reduced cardiovascular disease risk observed after smoking cessation.
Each year, smoking contributes to >443,000 smoking-related deaths in the United States and few millions in the rest of the world; and nearly 20% of all coronary heart disease deaths can be attributed to smoking. Although the strong relationship between smoking and cardiovascular disease (CVD) has been well-documented, the mechanisms by which smoking increases CVD risk appear to be multifactorial and incompletely understood. Clinical trials, suggest that cigarette smoking is associated with a more atherogenic lipid profile characterized by higher total cholesterol and triglycerides (TG) with lower levels of high-density lipoprotein cholesterol (HDL-C).
References:
1 Center for Disease Control and Prevention : Smoking-attributable mortality, years of potential life lost, and productivity losses—United States. 2002-2004. [accessed 2009 Apr 8]Morb Mortal Wkly Rep 57. 1226-1228.2008;
2 American Heart Association : Heart disease and stroke statistics—2009 update. American Heart AssociationDallas (Tex)2009.
3 Doll R., Peto R., Boreham J., et al: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 328. 1519.2004;
4 Freund K.M., Belanger A.J., D'Agostino R.B., et al: The health risks of smoking. The Framingham Study: 34 years of follow-up. Ann Epidemiol 3. 417-424.1993;
5 Ambrose J.A., Barua R.S.: The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43. 1731-1737.2004;
6 Gossett L.K., Johnson H.M., Piper M.E., et al: Smoking intensity and lipoprotein abnormalities in active smokers. J Clin Lipidol 3. 372-378.2009;
Novel and new oral antithrombotic drugs for prevention of VTE
Patients undergoing surgery receive anticoagulation for perioperative thromboprophylaxis or ischemic cardiovascular disease. Because anticoagulants may also potentiate bleeding, clinicians need to understand the implications of anticoagulation in perioperative and postoperative patient management. Many newer anticoagulants that are now available or are in clinical development do not require routine coagulation monitoring, have more predictable dose responses, and have fewer interactions with other drugs and food. The most advanced oral anticoagulants in clinical development are the direct factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran etexilate. These agents have been evaluated in the postoperative setting in patients undergoing total hip- or knee-replacement surgery with promising results, and it remains to be seen whether these results will translate into other surgical settings. The impact of the new agents will be influenced by the balance between efficacy and safety, improved convenience, and potential cost-effectiveness benefits.
Patients undergoing surgery receive anticoagulation for perioperative thromboprophylaxis or ischemic cardiovascular disease. Because anticoagulants may also potentiate bleeding, clinicians need to understand the implications of anticoagulation in perioperative and postoperative patient management. Many newer anticoagulants that are now available or are in clinical development do not require routine coagulation monitoring, have more predictable dose responses, and have fewer interactions with other drugs and food. The most advanced oral anticoagulants in clinical development are the direct factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran etexilate. These agents have been evaluated in the postoperative setting in patients undergoing total hip- or knee-replacement surgery with promising results, and it remains to be seen whether these results will translate into other surgical settings. The impact of the new agents will be influenced by the balance between efficacy and safety, improved convenience, and potential cost-effectiveness benefits.
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