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Early statin therapy in acute coronary syndromePatients who survive an acute coronary syndrome are at much higher risk of a recurrent event within the following month than patients with stable coronary syndromes. Statin therapy lowers the risk of recurrent events for many years but also reduces the risk of another event within the weeks to months following the initial acute coronary syndrome. The mechanisms that contribute to this benefit are likely related to improved endothelial function, decreased vascular inflammation, and reduced prothrombotic factors. Observation studies show an early reduction in mortality with statin therapy started before discharge from the hospital after an acute coronary syndrome.
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SABCS Interview SeriesThe January issue of OBTN featured highlights from the 32nd Annual San Antonio Breast Cancer Symposium (SABCS). We wrap up our SABCS coverage this month with interviews on denosumab with Alison Stopeck, MD, associate professor of medicine at the University of Arizona and director of the Clinical Breast Cancer Program at the Arizona Cancer Center; oral bisphosphonates with Rowan T.Chlebowski, MD, PhD, professor and chief of the Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center; and adjuvant chemotherapy�induced alopecia with Hugues Bourgeois, MD, Centre Jean Bernard in Lemans, France.
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New Guidelines Back Mammograms Starting at Age 40The American College of Radiology and the Society of Breast Imaging have issued new guidelines recommending that mammograms begin at 40 for women with an average risk of breast cancer and by 30 for high-risk women.
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Can You Hear Me Now?Despite major advances in communication technologies, numerous hospitals and clinics still use overhead paging, intercoms, Walkie Talkies, and other antiquated methods to reach staff members.
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Noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiographyWe evaluated the accuracy of the 64-slice computed tomography (CT) angiography scanner in subjects who were scheduled to undergo invasive angiography for possible stenosis in coronary artery bypass grafts. Results showed that the improved resolution of CT scanners with 64-slice technology allowed for a precise delineation of bypass graft occlusion or stenosis. It permitted an accurate noninvasive assessment of bypass grafts, even in subgroups of subjects with suboptimal scan conditions, such as those with arrhythmias or higher heart rates.
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Medication May Worsen Sleep Instability in Patients with Parkinson DiseasePatients with Parkinson disease had more pronounced sleep instability than those with other disorders marked by alpha-synuclein buildup, but those differences diminished after adjusting for medication differences, a new study found.
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Effect of Inadequate Response to Treatment in Patients With DepressionThis study sought to assess the effects of inadequate response to antidepressant treatment on healthcare resource utilization and on work productivity in patients diagnosed as having major depressive disorder.
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Extreme lipoprotein(a) levels and myocardial infarctionWe conducted a study to determine whether high lipoprotein(a) levels predicted the risk of myocardial infarction (MI) and ischemic heart disease. Unlike other studies, we measured lipoprotein(a) levels shortly after sampling and corrected for regression dilution bias.
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Trends in stroke over the past 50 years: The Framingham StudyA significant reduction in the age-adjusted incidence of stroke in men and women and 30-day mortality in men was shown in a community-based cohort study with biennial assessment of vascular risk factors and active surveillance for incident stroke over the past 50 years. Lifetime risk, severity of stroke, and 30-day mortality in women were stable. Increased life expectancy results in an increase in lifetime risk. This increased longevity is balanced by improvements in risk factor management, yielding no significant change.
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Newborn with Facial MarksThis newborn was noted to have these facial lesions at time of birth. On further exam there is some erythema on the nape of the neck. The parents indicate that the color seems to be more or less prominent at various times. The pregnancy and delivery were otherwise uncomplicated.
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Management of Acute GI Bleeding in Primary Care: An UpdateUpper gastrointestinal bleeding is a common medical emergency that continues to be a significant cause of morbidity and mortality. It requires rapid and appropriate intervention to control the associated hemodynamic instability and prevent continued or recurrent bleeding. Etiology is the key to prognosis. Lower gastrointestinal bleeding usually ceases spontaneously but may also result in hemodynamic instability or symptomatic anemia. Recognizing the signs and symptoms of upper versus lower gastrointestinal bleeding is crucial for prompt and appropriate treatment.
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Revascularization in patients 75 years or older with diabetes mellitus and angina pectorisWe analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.
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Initiating treatment for chronic heart failureStandard congestive heart failure treatment begins with an angiotensin-converting enzyme (ACE) inhibitor to which a beta-blocker is added once the target dose of the ACE inhibitor has been reached. We compared morbidity and mortality between standard treatment and treatment using the reverse sequence, that is, the beta-blocker bisoprolol was given to patients first, followed by the ACE inhibitor enalapril. Results showed that both sequence strategies were safe and effective, with a survival trend in favor of the bisoprolol-first strategy.
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Community-acquired MRSA pericarditisOnly 2 cases of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pericarditis have been reported in the English literature. Over the last 15 years, CA-MRSA has emerged as an increasingly common pathogen that is genetically and epidemiologically different from hospital-acquired MRSA (HA-MRSA).
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Assessing and Treating Complex MigraineProper diagnosis and treatment requires that physicians and patients understand the symptoms and clinical presentation of this complicated migraine condition.
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Hyperglycemia and platelet function in diabetic patients: Relevance to acute myocardial ischemia and infarctionDiabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.
