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Tales of the Anion Gap, Part II: Metabolic AcidosisIn this installment, we look at underlying causes of metabolic acidosis, approaches for evaluating patients with suspected metabolic acidosis, and why measurement of the anion gap is of great usefulness in these cases.
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Increased risk of cardiovascular disease among middle-aged women due to glycemic loadWe conducted a study among 15 714 Dutch middle-aged women consuming modest-glycemic-load diets. Results showed that high dietary glycemic load and glycemic index increased the risk of cardiovascular disease. This association was particularly evident among overweight women. Recommendations to follow a high-carbohydrate diet may therefore not be optimal in the prevention of cardiovascular diseases.
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Transcatheter Aortic Valve Replacement Is an Effective Alternative to Surgical ReplacementData from the PARTNER cohort A trial show transcatheter aortic valve replacement produces similar mortality rates at one year compared with the standard procedure.
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Regular Visits with Provider Key to Patients Maintaining Weight Loss from Lifestyle ModificationsThe 2013 revision of guidelines on managing overweight and obesity in adults suggests that providers and patients set a goal of a sustained weight loss of 3-5% of baseline body weight to obtain improvements in triglycerides, blood glucose, HbA1c, and the risk of developing type 2 diabetes mellitus.
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Chest pain syndrome in women: A diagnostic dilemmaThe ability to diagnose coronary artery disease (CAD) in women may be limited by the sensitivity and specificity of symptoms as well as of noninvasive testing. The choice of which test should be performed to evaluate the presence of CAD in women remains controversial. Currently American Heart Association/American College of Cardiology guidelines recommend initial evaluation with exercise electrocardiogram (ECG) testing. In a meta-analysis of 3721 women, however, exercise ECG had a sensitivity of 61% and a specificity of 70%1 as compared to 68% sensitivity and 77% specificity in men.
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Cholesterol-lowering therapies and C-reactive proteinLow-density lipoprotein (LDL) cholesterol-lowering therapy decreases C-reactive protein (CRP) levels, but the importance of LDL cholesterol-independent effects is uncertain because of the variability in measuring LDL cholesterol and CRP levels in any individual patient. In this study, this variability was reduced by comparing average changes in LDL cholesterol and CRP levels after treatment with lipid-lowering therapy across different studies.
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Novel Oral Testosterone Replacement Therapy Is Safe and Effective in Clinical TrialsTreatment with LPCN 1021 restored and maintained testosterone levels at rates comparable to approved non-oral products.
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Is circulating heat shock protein 60 a marker for susceptibility to cardiovascular disease in patients with diabetes?The vital cell stress protein, heat shock protein (Hsp)60, has recently been found in the circulation of healthy subjects over an extremely large concentration range. We performed an analysis of subjects with diabetes to determine whether Hsp60 is associated with biochemical markers of cardiovascular disease. Results showed that high circulating levels of Hsp60 are associated with clinically manifest cardiovascular disease. Hsp60 has cytokine-like actions, which may be responsible for this association.
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Rapid Triage Testing Could Improve Outcomes for Patients with Acute Kidney InjuryDavid Ludvigson and Nam Tran, PhD, write about the need for rapid triage testing as a method of improving outcomes for patients with acute kidney injury.
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So when should sinus rhythm be restored?This review summarizes an important substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial, which randomized 522 patients with atrial fibrillation (AF) to rate versus rhythm control treatment strategies and followed them for up to 2.3 years with a primary composite endpoint that included cardiovascular mortality, heart failure, thromboembolic complications, bleeding, severe adverse effects of anti-arrhythmic agents, and pacemaker implantation.
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How a Cruise Can Simplify Your VacationCruises not only simply the vacation experience, but they also enable visits to countries that might be difficult to navigate otherwise.
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Gene Therapy Shows Promise in Neutralizing HIVResearchers safely infuse engineered immune cells in groundbreaking gene therapy study.
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Double infarct syndrome: Simultaneous subacute ST-segment elevation myocardial infarction involving the right coronary and the left circumflex arteriesRuptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients.Goldstein et al found features of instability of nonculprit plaques in nearly 40% of patients by angiography,1 whereas actual rupture in a remote site other than the angiographic culprit lesion was found in approximately 13% to 79% of cases when evaluated by intravascular ultrasound.
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Intracranial hemorrhage in atrial fibrillation: Is there a racial/ethnic difference?We evaluated a multiethnic cohort of subjects with nonrheumatic atrial fibrillation hospitalized over a 6-year period to determine the racial and ethnic differences in the risk of intracranial hemorrhage (ICH) and the effect of warfarin treatment on ICH risk. Treatment with warfarin was associated with a 2-fold greater risk of ICH in whites, a 4- to 5-fold greater risk in both blacks and Hispanics, and a 15-fold greater risk in Asians. After adjusting for established stroke risk factors and warfarin use, Asians were 4 times as likely as whites to have ICH, whereas blacks and Hispanics were twice as likely.
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Smartphones Moving to the Front Line of Mobile Technology for PhysiciansTraditionally, physicians have relied on textbooks, conferences, and, more recently, the Internet to keep abreast of the latest clinical data and support clinical decision-making
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How Should I Manage This Man's Hyperthyroidism?Though laypeople are sensitized to associating "radioactive" with "cancer," this is an unwarranted fear when considering radioactive iodine ablation for hyperthyroidism.
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Mortality of patients with diabetes mellitus and acute myocardial infarctionWe evaluated trends in the treatment and mortality of patients with and without diabetes mellitus and acute myocardial infarction over the last decade. Despite improvements in the provision of evidence-based care, patients with diabetes did not derive improvements in long-term survival.
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Body mass index and risk of stroke in womenAlthough several studies have found a positive association between body mass index (BMI) and stroke in men, the association in women is less clear. We evaluated women enrolled in the Women's Health Study and found that increased BMI was a strong risk factor for total and ischemic stroke. These results show that the number of total and ischemic strokes may be reduced if obesity is prevented.
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Chronic diuretic use and increased mortality and hospitalization in heart failureDiuretic use is associated with activation of neurohormones and disease progression in heart failure. Yet, diuretics are commonly prescribed, although little is known about their long-term effects. We performed a study based on propensity score matching, which indicated that in subjects with ambulatory, chronic, mild-to-moderate heart failure, diuretic use was associated with increased mortality and hospitalization. These findings call into question the wisdom of using long-term diuretic therapy in heart failure patients who are asymptomatic or minimally symptomatic.
