Myocardial infarction stroke risk

Therapeutically t-PA and urokinase are the most important drugs for fibrinolytic therapy (myocardial infarction, stroke, massive pulmonary embolism). This treatment is associated with an enhanced risk of bleeding complications. 

Typical complications include insomnia and excessive daytime sleepiness due to frequent nighttime awakenings. Sleep electroencephalogram (EEG) reveals absent or decreased slow-wave sleep, and, in some patients, early-onset REM sleep. If untreated, long-term effects of sleep apnea include increased incidence of hypertension vascular events (e.g., myocardial infarction, stroke) poor work performance increased risk of traffic accidents and stress in personal relationships ( 22, 23). 

Tight control of diabetes, with reduction of HbAic from 9.1% to 7%, was shown to reduce the risk of microvascular complications overall compared with that achieved with conventional therapy (mostly diet alone, which decreased HbAic to 7.9%). Cardiovascular complications were not noted for any particular therapy metformin treatment alone reduced the risk of macrovascular disease (myocardial infarction, stroke). Epidemiologic analysis of the study suggested that every 1% decrease in the Aic achieved an estimated risk reduction of 37% for microvascular complications, 21% for any diabetes-related endpoint and death related to diabetes, and 14% for myocardial infarction. 

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease. The Women s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 19 years of age) during 5 years of treatment with oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo.62... 

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. 

Several prospective studies have shown that markers of inflammation, such as sensitive C-reactive protein and serum amyloid A (S-AA), are predictors of increased risk for myocardial infarction, stroke, or peripheral vascular disease (53-56). 

Sildenafil was the first oral treatment for ED and is the most extensively evaluated (35). Overall success rates in patients with cardiovascular disease of 80% or greater have been recorded with no evidence of tolerance, Patients with diabetes with or without additional risk factors, with their more complex, and extensive pathophysiology, have an average success rate of 60%. In randomized trials to date, open-label or outpatient monitoring studies the use of sildenafil is not associated with any excess risk of myocardial infarction, stroke, or mortality (38-40), In patients with stable angina pectoris there is no evidence of an ischemic effect due to coronary steal, and in one large, double-blind, placebo-controlled, exercise study sildenafil 100 mg increased exercise time and diminished ischemia (41), A study of the hemodynamic effects in men with severe CAD identified no adverse cardiovascular effects and a potentially beneficial effect on coronary blood flow reserve (42), Studies in patients with and without diabetes have demonstrated improved endothelial function acutely and after long-term oral dose administration, which may have implications beyond... 

The current consensus is that the contemporary low-dose preparations pose minimal risks in women who have no predisposing risk factors and, in fact, may provide certain beneficial health effects (e.g., protection against endometrial and ovarian cancer). Oral contraceptive pills have been associated with increased risk for myocardial infarction, stroke, and venous thromboembolism. However, studies have been published that suggest that these risks are minimal in appropriately chosen low-risk women. 

Hgwo 24.1. Proportional effects of antiplatelet therapy on vascular events (myocardial infarction, stroke, or vascular death) in four main high risk categories of trial and in low risk (primary preventim). 

HMG Co-A reductase inhibitors (statins) have been shown to reduce the incidence of fatal and non-fatal myocardial infarction, stroke and mortality (all causes), as well as the need for coronary artery bypass surgery. Since no single drug has been shown to be significantly more effective or less expensive than others in the group, none is included in the model list the choice of drug for use in patients at highest risk should be decided at national level. 

Ridker PM, Hennekens CH, Lindpaintner K, el al. Mutation in the gene coding for coagulation factor V and the risk of myocardial infarction, stroke, and venous thrombosis in apparently healthy men. NEngl J Med 1995 332(l4) 912-7. 

ACE Inhibitors in Patients Who Are at High Risk of Cardiovascular Events Patients at high risk of cardiovascular events (no left ventricular dysfunction but evidence of vascular disease or diabetes and one other risk factor for cardiovascular disease) benefit considerably from ACE inhibitors, with significant decreases in the rates of myocardial infarction, stroke, and death. The benefits of ACE inhibition in patients at high risk of cardiovascular events persist even after coronary revascularization. 

Type-2 diabetes mellitus is known to increase dramatically the risk of cardiovascular death, as shown, among several other studies, in the large cohort of 340,000 men screened in the Multiple Risk Factor Intervention Trial 11], Useful information has also been provided by the Hypertension Optimal Treatment (HOT) study [2], with analyses comparing cardiovascular outcomes in 1,503 diabetic hypertensives and 17,230 non-diabetic hypertensives, all subjected to intense antihypertensive treatment incidences of myocardial infarction, stroke, all major cardiovascular events, cardiovascular and all-cause mortalities were much higher in diabetics than in non-diabetics with relative risk of 1.45-2.13 even after adjusting for all other baseline risk factors (Fig. 1). Calculations from a recent meta-analysis of antihypertensive treatment trials... 

The PPP (Primary Prevention Project) study [15] was a randomized, controlled (no placebo), open trial investigating low-dose aspirin (100 mg daily) in 4,495 subjects (42.5% males) with one or more cardiovascular risk factors. Follow-up was 3.6 years. Aspirin was found to lower the frequency of all the end points, being statistically significant for cardiovascular death (relative risk 0.56), and total cardiovascular events (relative risk 0.77), with non-significant reduction in myocardial infarction (relative risk 0.69) and stroke (risk reduction 0.67). Seven hundred and forty-two diabetics (17%) were included in the study but no separate information on this subgroup is provided in the original publication. 

The SMQs consist of different adverse event terms with the objective to describe a common medical concept. In an attempt to increase the sensitivity of the assessment, it is quite common to combine search terms for medically closely related concepts, that is, to use a composite endpoint for the assessment of risks. A typical example of a composite safety endpoint is the major adverse cardiovascular events (MACE) criterion. This endpoint consists of myocardial infarction, stroke, and cardiovascular death. While this approach is very appealing at a first glance, great caution should be applied when using these composite endpoints. As in the case of MACE, the individual components of the composite do not necessarily have the same medical importance. Therefore, the results of the individual components of the composite should always be reported in addition to the overall result. This is particularly important if equivalence or noninferiority of the overall risk is to be claimed, and then it would also be interesting to know whether a treatment reduces the risk of stroke at the expense of an increased risk of cardiac mortality. 

Cardiovascular The use of glucocorticoids is associated with increased risks of myocardial infarction, stroke, and heart failure, but data are limited on the risk of atrial fibrillation and atrial flutter. In a case-control study patients with a first hospital diagnosis of atrial fibrillation or flutter were identified in Northern Denmark p "]. For each case 10 population controls matched by age and sex were selected. 

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