Cardiovascular deaths

Exercise tolerance (stress) testing (ETT) is recommended for patients with an intermediate probability of CAD. Results correlate well with the likelihood of progressing to angina, occurrence of acute MI, and cardiovascular death. Ischemic ST-segment depression during ETT is an independent risk factor for cardiovascular events and mortality. Thallium myocardial perfusion scintigraphy may be used in conjunction with ETT to detect reversible and irreversible defects in blood flow to the myocardium. 

Ranolazine is indicated for the treatment of chronic angina. Based on controlled trials, the improvement in exercise time is a modest increase of 15 to about 45 seconds compared with placebo. In a large ACS trial, ranolazine reduced recurrent ischemia but did not improve the primary efficacy composite end point of cardiovascular death, MI, or recurrent ischemia. 

Metformin should be included in the therapy for all type 2 DM patients (if tolerated and not contraindicated) because it is the only oral antihypergly-cemic medication proven to reduce the risk of total mortality and cardiovascular death. 

The CURE study involved 12,562 patients randomized to receive Plavix (300 mg loading dose followed by 75 mg daily) or placebo and were treated for up to a year. Patients also received aspirin or other standard treatment such as heparin. The results showed that Plavix had a 20% relative risk reduction compared with placebo (582 cases of cardiovascular death, myocardial infarction, or stroke) versus 719 cases for placebo. 

Acute coronary syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave Ml) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or coronary artery bypass graft (CABG), clopidogrel has been shown to decrease the rate of a combined endpoint of cardiovascular death. Ml, or stroke, as well as the rate of a combined endpoint of cardiovascular death. Ml, stroke, or refractory ischemia. 

Cardiovascular Death from cardiac arrest has occurred after too-rapid IV administration, sometimes preceded by marked QRS widening. Administer cautiously in the presence of advanced AV block. Do not exceed an IV infusion rate of 50 mg/min. 

Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones a meta-analysis of randomised clinical trials. Lancet 2007 370 1129-36. 

Evidence-based pharmacotherapy provides a succinct appreciation of the benefits of a drug, but rarely takes into account the patient s quality of life. Eor instance, intensive statin therapy is recommended because it reduces the incidence of cardiovascular death (odds ratio 0.86), myocardial infarction (odds ratio 0.84), and stroke (odds ratio 0.82) however, the increased risks for any adverse event (odds ratio 1.44), for abnormalities on liver function testing (odds ratio 4.48), for elevations in CK (odds ratio 9.97) and for adverse events requiring discontinuation of therapy (odds ratio 1.28) are less often taken into account by the prescriber. This example emphasises that individualisation is of the utmost importance to keep an acceptable benefit/risk ratio (Clin Ther 2007 29 253-60). The benefits of evidence-based pharmacotherapy may be obtained whenever concordance/compliance of the patient is adequate. However, concordance rate is slightly higher than 30% for chronic conditions, such as hypertension (Curr Hypertens Rep 2007 9 184-9), indicating that the patient has to be educated about the use of drugs, and therapy has to be individualised. 

Atherosclerosis is main cause of cardiovascular deaths. It is characterized by a localised plaque in the intima and is composed of cholesterol esters, deposition of fibrous proteins and calcification. These plaques may narrow the arterial lumen and can cause distalischemia. The coronary and cerebral circulation are main sites of atherosclerosis. Raised levels of VLDL, LDL... 

Hirvonen E, Idanpaan-Heikkila J. Cardiovascular death among women under 40 years of age using low-estrogen oral contraceptives and intrauterine devices in Finland from 1975 to 1984. Am J Obstet Gynecol 1990 163(1 Pt 2) 281 1. 

Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk of idiopathic cardiovascular death and nonfatal venous... 

In a retrospective study, cardiovascular deaths in patients using a sulfonylurea only (n = 741) were compared with deaths in patients taking a sulfonylurea + metformin (n = 169) (41). In patients taking the combination the adjusted odds ratios (95% Cl) were ... 

There is now good evidence for a role of presynaptic neuropeptide Y receptors in disease states. As to the cardiovascular system, plasma neuropeptide Y levels are slightly increased in hypertensive patients and to a greater extent in cardiac failure (Morris 2004). An increase in neuropeptide Y levels is even an important prognostic marker for cardiovascular death in hemodialysis patients (Odar-Cederlof et al. 

This indication was considered in three trials. The first was the PCI-CURE study (44) (n = 2658 patients), a prespecified subgroup analysis of CURE. This trial studied the benefit of pretreatment with clopidogrel (median 10 days) before PCI. At one-month follow-up, there was a significant (P = 0.04) reduction of cardiovascular death and Ml (from 4.4% to 2.9%). 

The CURE trial investigated the efficacy and safety of clopidogrel in 12,562 patients when administered together with aspirin in patients with ACS (UA or non-Q-wave Ml). The combination demonstrated a 20% relative risk reduction in the combined endpoints of Ml, stroke, or cardiovascular death compared with placebo (31). 

Several direct thrombin inhibitors have been studied in NSTEMI and STEM I patients and were compared to unfractionated heparin. In the GUSTO lib- and OASIS-2 trial (42,43), hirudin was studied versus heparin in patients with ACS. Despite early benefits, no statistical significance could be demonstrated at 30 days. Together with the OASIS-1 data, a combined analysis indicated a 22% relative risk reduction in cardiovascular death or Ml at 72 hours, 17% at 7 days, and 10% at 35 days (42). 

Eikelboom JW Hirsh J, Weitz Jl, Johnston M, Yi Q, Yusuf S. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002 105 1650-1655. 

CHAOS 400/8001U (RRRT) 510 day 2002 M-F Reduction of composite cardiovascular death and fatal myocardial infarction 131... 

However, a meta-analysis of seven randomized trials of vitamin E (27) that involved 81,788 cases for a follow-up between I. I and 6.3 years and at a dosage range between 50 and 800mg/day concluded, "Vitamin E did not provide benefit in mortality compared with the control group or significantly decrease risk of cardiovascular death or cerebrovascular accident,"... 

TRACE (88) Acute Ml within 3-7 days LVEF < 35% 2606 Trandolapril. 4-mg once per day, vs. placebo 22% Reduction of overall mortality lower risk of cardiovascular death, severe HF, and sudden death... 

Patients with PAD have increased mortality risk from cardiovascular causes (4,5), which is significantly increased in the subgroup of patients with high serum homocysteine concentration (33,34). Association of a low ABI and high homocysteine level could be useful for identifying patients at excess risk for cardiovascular death (34). In spite of the efficacy in lowering homocysteine level with a folic acid supplement there is no evidence that reducing homocysteine concentration is beneficial in patients with CHD and PAD (26,35),... 

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