Myocardial Ischemia Reduction with Aggressive

Patients enrolled early after acute coronary syndromes Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) (21), Fluvastatin On Risk... 

Abbreviations ACS. acute coronary syndrome AECG. ambulatory electrocardiogram FLORIDA, fluvastatin on risk diminishment after acute myocardial infarction Ml. myocardial infarction MIRACL, myocardial ischemia reduction with aggressive cholesterol lowering nfMI. nonfatal myocardial infarction PACT, pravastatin in acute coronary treatment PROVE-IT TIMI 22. pravastatin or atoivastatin evaluation and infection therapy—thrombolysis in myocardial infarction 22 UAP, unstable anginapectoris. 

Fraley AE, Schwartz GG, Olsson AG et al. Relationship of oxidized phospholipids and biomarkers of oxidized low-density hpoprotein with cardiovascular risk factors, inflammatory biomarkers, and effect of statin therapy in patients with acute coronary syndromes Results from the MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) trial. Journal of the American CollMe of Cardiology 2009 53 2186-2196. 

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

In the decompensated patient who presents with heart failure and normal systemic vascular resistance, afterload reduction may be contraindicated, and treatment with a parenteral agent such as dobutamine may be preferable. The risk attendant to treatment with sympathomimetic drugs is related to the increase in myocardial Oj consumption that may occur this is of particular concern in patients with left heart failure that occurs as a direct consequence of myocardial ischemia. This clinical quandary has become less common in the era of aggressive myocardial revascularization when it is encountered, coadministration of dobutamine with parenteral nitroglycerin should be considered. 

---