Aspirina prevencion de recurrencias de Trombosis venosa profunda

Aspirin May Prevent Recurrence of Deep Vein Blood Clots: MedlinePlus Mobile

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La duración del QRS en reposo pronostica la muerte súbita en los hombres

La duración del QRS en reposo pronostica la muerte súbita en los hombres
2012-05-25 11:11:35.0 | REED MILLER
(Artículo original en inglés, heartwire; 22 mayo 2012) Kuopio, Finlandia — Los resultados de un nuevo estudio publicado el 21 de mayo de 2012 en la versión en línea de Circulation muestran que un complejo QRS incluso moderadamente prolongado puede señalar un incremento del riesgo de muerte cardiaca súbita [1].

Investigaciones previas han demostrado que el intervalo QRS prolongado en un electrocardiograma se asocia a un incremento del riesgo de muerte cardiaca súbita. Sin embargo, las encuestas epidemiológicas extensas aún no han identificado indicadores específicos de muerte cardiaca súbita en una población general, según el investigador principal Dr. Sudhir Kurl (Universidad del Este de Finlandia, Kuopio).

Kurl y sus colaboradores analizaron la relación del complejo QRS con la muerte cardiaca súbita en una muestra de 2049 hombres de 42 a 60 años de edad al inicio con un seguimiento de 19 años. «Queríamos identificar nuevos indicadores clínicos útiles de muerte cardiaca súbita, ya que ésta suele ocurrir poco después del inicio de los síntomas y deja poco tiempo para las intervenciones clínicas eficaces, y el electrocardiograma en reposo es la herramienta diagnóstica utilizada con más frecuencia en el ejercicio clínico».

Durante el seguimiento a 19 años, se presentaron 156 muertes cardiacas súbitas en el estudio; como una variable continua, cada incremento de 10 ms en la duración del QRS se relacionó con un incremento del 27% en el riesgo de muerte cardiaca súbita (riesgo relativo: 1,27; p < 0,001). Los hombres en el estudio con una duración de QRS de 110 ms — el quintil más alto — tuvieron 2,5 más probabilidades de sufrir muerte cardiaca súbita (p = 0,002) que los sujetos del estudio con un QRS menor de 96 ms — el quintil más bajo — después del ajuste con respecto a factores de riesgo demográficos y clínicos tales como edad, consumo de alcohol, IM previo, tabaquismo, concentraciones séricas de lipoproteína de baja y alta densidad, proteína C reactiva, diabetes de tipo 2, índice de masa corporal, tensión arterial sistólica y aptitud cardiorrespiratoria.

Además de la duración del QRS, el tabaquismo, el IM previo, la diabetes de tipo 2, la aptitud cardiorrespiratoria, el índice de masa corporal, la tensión arterial sistólica y la proteína C reactiva también se relacionaron de manera independiente con un incremento del riesgo de muerte cardiaca súbita.

Kurl dijo a heartwire: «Nuestros resultados muestran que incluso una duración de QRS moderada — que supere 110 ms, lo que comprende bloqueos parciales de rama — representa un factor de riesgo para muerte cardiaca súbita. El riesgo persistió aun después de tomar en cuenta la función del ventrículo izquierdo».

Dijo: «Este estudio muestra que el ECG se debiera llevar a cabo con regularidad para que el médico pueda evitar la muerte cardiaca súbita mediante el empleo de diversas intervenciones en caso de que sea prolongada la duración del QRS». «Por el momento no tenemos indicadores de riesgo específicos para muerte cardiaca súbita en la población general. Todavía carecemos de la estratificación de riesgo eficaz y de las intervenciones preventivas para la mayoría de las personas que finalmente presentarán muerte cardiaca súbita».

Los autores declaran no tener ningún conflicto de interés económico pertinente.
Referencia
Kurl S, Makikallio T, Rautaharju P, et al. Duration of QRS complex in resting electrocardiogram is a predictor of sudden cardiac death in men. Circulation 2012; DOI: 10.1161/CIRCULATIONAHA.111.025577. Disponible en: http://circ.ahajournals.org.

Antiarrhythmic drugs for the maintenance of sinus rhythm: Risks and benefits

Antiarrhythmic drugs for the maintenance of sinus rhythm: Risks and benefits John Camm Corresponding author at: St. George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom. Tel.: +44 20 8725 3413; fax: +44 20 8767 7141. Abstract  Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice, and its complications impose a significant economic burden. The development of more effective agents to manage patients with AF is essential. While clinical trials show no major differences in outcomes between rate and rhythm control strategies, some patients with AF require treatment with antiarrhythmic drugs (AADs) to maintain sinus rhythm, reduce symptoms, improve exercise tolerance, and improve quality of life. Currently available AADs, while effective, have limitations including limited efficacy, adverse events, toxicity, and proarrhythmic potential. The 6 most commonly used AADs (amiodarone, disopyramide, dofetilide [USA but not Europe], flecainide, propafenone, sotalol) have proarrhythmic effects (fewer with amiodarone). Amiodarone is the most effective AAD, but its safety profile limits its usefulness. Recent advances in AAD therapy include dronedarone and vernakalant. Dronedarone, approved by the United States Food and Drug Administration and the European Medicines Authority and others, has been proven efficacious in maintaining sinus rhythm and reducing the incidence of hospitalization due to cardiovascular events or death in patients with AF. The intravenous formulation of vernakalant is approved in the European Union, Iceland, and Norway. Oral vernakalant is currently undergoing evaluation for preventing AF recurrence and appears to be effective with an acceptable safety profile. Treatment should be individualized to the patient with consideration of pharmacologic risks and benefits according to AF management guidelines. Accumulating efficacy and safety data for new and emerging AADs holds promise for improved AF management and outcomes. Research Highlights ► Maintenance of sinus rhythm is an important strategy in patients with AF. ► Currently available AADs have limitations including limited efficacy and AEs. ► Recent advances in AAD therapy include dronedarone and vernakalant.

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Sudden Death in Athletes: Debate Continues

By Peggy Peck, Executive Editor, MedPage Today Published: May 06, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Action Points

• The latest NCAA data for division I puts the risk of sudden cardiac death each year at about one in 3,000.
• Note that the risk appears to be as much as 9 times greater for male athletes.

DUBLIN -- Relying on media reports is no basis for estimating the incidence of sudden cardiac death in athletes, nor does it provide the necessary basis to establish policy on the use of 12-lead electrocardiograms (ECGs) in pre-participation physicals, researchers agree.

Yet, news reports about the death of Norwegian Olympic swimmer Alexander Dale Oen, 26, on April 30 at an Arizona training facility fueled hallway discussions throughout the 3-day long EuroPRevent 2012 meeting here.

Although the cause of death is not yet known, the incident focused attention on the ongoing debate about the risk of sudden death in athletes -- and whether that risk increases as the level of competition increases.

Mats Borjesson, MD, of Sahlgrenska University Hospital/Ostra at Goteborg University in Goteborg, Sweden, and Nicole Panhuyzen-Goedkoop, MD, of Sports Medisch Centrum in Papendal, The Netherlands, said the best available data put the incidence at 1-3 per 100,000 person years, but both pointed out that this estimate is probably low.

A study published last year in Circulation: Journal of the American Heart Association, reported that 1 in 44,000 National Collegiate Athletic Association athletes is a victim of sudden cardiac death each year, but Borjesson said that "the latest NCAA data for division I puts the risk at about one in 3,000."

And the risk appears to be gender specific, estimated to be as much as 9 times greater for male athletes.

The most common causes are inherited or congenital cardiac disease, often ion channelopathies, but blunt trauma to the chest causing commotio cordis is also a factor, as is infection, Panhuyzen-Goedkoop said.

In an interview, Borjesson said the possibility of infective endocarditis should not be underestimated, "so we don't want athletes participating when they are sick."

But Borjesson emphasized the need for solid data -- data from ECGs -- to take the guessing out of sudden death incidence and to save lives.

In the U.S. there has been resistance to ECGs for pre-participation screening based on the low-risk for sudden cardiac death and the cost of screening. Current recommendations call for clinical examination and ECG only if the exam is inconclusive or if an ECG is needed to confirm a diagnosis.

"Symptoms before SCD include syncope, chest pain, palpitations, dyspnea, and fatigue -- problems that are diffuse and common, which cannot be adequately assessed with a history and clinical exam," Borjesson said.

And he agreed that using ECG would identify more athletes at risk and would likely result in more treatment, thus more cost, but "if you are going fishing, you buy the boat, hire the fisherman and the equipment so that you catch more fish. With the ECG we can catch more fish."

Borjesson and Nicole Panhuyzen-Goedkoop declared no financial conflicts.

Primary source: European Association for Cardiovascular Prevention & Rehabilitation
Source reference:
Panhuyzen-Goedkoop N "Incidence and causes of sudden death in sport" EuroPRevent 2012; Presentation 232.

Additional source: European Association for Cardiovascular Prevention & Rehabilitation
Source reference:
Borjesson M "Role of electrocardiogramme in pre-participation cardiovascular screening of athletes" EuroPRevent 2012; Presentation 233.

Observational Studies Show Vitamin D May Benefit Cardiovascular, Skin and Metabolic Disorders

Observational Studies Show Vitamin D May Benefit Cardiovascular, Skin and Metabolic Disorders CHEVY CHASE, MD -- May 18, 2012 -- The Endocrine Society’s new scientific statement published online today represents the first comprehensive evaluation of both the basic and clinical evidence related to the non-skeletal effects of vitamin D. The statement addresses current research regarding the associations of vitamin D with immune function, hypertension, stroke, skin conditions and maternal/fetal health. Vitamin D deficiency is common throughout the world and results in abnormalities of calcium, phosphorus and bone metabolism which can lead to muscle weakness, osteomalacia, osteopenia and osteoporosis. While some observational studies have shown that benefits of vitamin D may extend beyond bone health, research findings remain inconsistent. “The role of vitamin D supplementation in the prevention and treatment of chronic non-skeletal diseases remains to be determined,” says Clifford Rosen, MD, Tufts University School of Medicine, Boston, Massachusetts. “We need large randomised controlled trials and dose-response data to test the effects of vitamin D on chronic disease outcomes including autoimmunity, obesity, diabetes, hypertension and heart disease.” The scientific statement outlines the evidence that defines the effects of vitamin D on epidermal, neuromuscular, maternal/fetal and neoplastic abnormal growth tissues. The authors critically evaluated the literature for each organ system utilising available evidence from observational studies and randomised trials to determine the strength of associations between vitamin D and tissue-specific outcomes. Conclusions from the statement include: •Topical and oral vitamin D may be useful in treating skin disorders such as psoriasis, though large-scale randomised placebo-controlled clinical trials are needed to demonstrate the efficacy of treatment with vitamin D on skin disorders or the prevention of skin cancer. •The ever-expanding obesity epidemic has been associated with a rising prevalence of vitamin D deficiency, but a cause-and-effect relationship has not been established. Strong evidence does not exist to support the tenet that vitamin D supplementation reduces the risk of type 2 diabetes or the metabolic syndrome. •Vitamin D supplementation is likely to reduce the risk of falls, particularly in individuals who have low baseline levels (<20 ng/ml) and are supplemented with calcium as well. •Recent systematic reviews have found that evidence that vitamin D reduces cancer incidence are inconclusive as to causality. Observational evidence is strongest for colorectal cancer but is weak or inconsistent for breast, prostate and total cancer. •There is a possibility that vitamin D supplementation may lower cardiovascular disease risk, but there are limitations in applying observational data to clinical practice. An insufficiency of evidence from clinical trials does not support recommending vitamin D supplementation for lowering cardiovascular disease risk at this time. •Clinical trials are needed to test whether vitamin D supplementation during pregnancy will prevent type 1 diabetes in offspring. The article, “The Nonskeletal Effects of Vitamin D: An Endocrine Society Scientific Statement,” appears in the June 2012 issue of The Endocrine Society’s Endocrine Reviews. SOURCE: The Endocrine society

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Cirugia no cardiaca, hipotension y necrosis miocardica

More than one in five patients at high cardiovascular risk show signs of heart muscle necrosis immediately after undergoing non-cardiac elective surgery, Australian research has found.
Seventy nine patients out of 352 undergoing elective surgery at a Sydney hospital showed elevation in a high-sensitivity troponin T assay (hs-TnT) in the 48 hours after their operation.
Only seven patients (2%) showed clinical evidence of MI, so without the very sensitive hs-TnT assay, the myocardial necrosis in the others would not have been detected, said the authors, led by Professor David Brieger of Concord Repatriation General Hospital.
Myocardial necrosis was more likely to occur in older patients; if there had been a period of hypotension during the operation; and if the operation was an orthopaedic procedure, the authors found.
Intraoperative hypotension (defined as systolic blood pressure of 100mg Hg or less) occurred in 70% of patients, lasting for about half an hour on average. Increasing the period of hypotension “strongly predicted myocardial necrosis.”
The findings suggested “The most common mechanism [for the myocardial necrosis] is likely to be a mismatch between myocardial oxygen supply and demand rather than thrombus formation on vulnerable plaque”, the authors said.
The authors measured hs-TNT in all the patients before the surgery and found that 31% had raised levels (greater than 14ng/litre). Having elevated levels before the operation did not increase the likelihood of myocardial damage during the operation.
The authors commented that a high incidence of perioperative cardiac events after orthopaedic surgery had been reported in other studies. They speculated that subclinical fat embolism could be an underlying cause.
All of the patients were on antiplatelet therapy and 80% were taken off this before the operation. The authors commented that this went against current guidelines, although no link was found between anti-platelet therapy cessation and perioperative myocardial necrosis in their cohort.
Heart 2012: doi:10.1136/heartjnl-2011-301577

Surgeons Offer Advice on Avoiding Varicose Veins

An estimated 50 percent to 55 percent of pregnant women in the United States develop varicose veins, according to the Society for Vascular Surgery.

"More than just a cosmetic issue, varicose veins can be painful and can lead to more serious health problems," Dr. Eva Rzucidlo, chair of the group's Women's Leadership Committee, said in a society news release.
"The first line of management for varicose vein treatment is medical management with compression stockings worn daily," Rzucidlo said.
"Another option is sclerotherapy, the sealing off of the veins -- mainly done for spider veins," she said. "Radiofrequency and laser treatments are also options which are minimally invasive procedures often performed in a doctor's office. For very large varicose veins, a surgical procedure known as vein stripping is available."
Pregnancy can cause varicose veins by putting pressure on the uterus, according to the U.S. Department of Health and Human Services' Office on Women's Health. Other factors that contribute to varicose veins include hormonal changes during puberty, pregnancy and menopause, obesity, lack of movement, a family history of varicose veins and increasing age.
Ways to reduce the risk of varicose veins or ease the discomfort include: maintaining a healthy weight, regular exercise, elevating legs when resting, avoiding sitting or standing for long periods of time, wearing elastic support stockings, eating a low-salt, high-fiber diet, and not wearing high-heel shoes for long periods of time

Fibrates: Therapeutic potential for diabetic nephropathy?

European J Internal Medicine
I. Kouroumichakis, N. Papanas, P. Zarogoulidis, V. Liakopoulos, E. Maltezos, D.P. Mikhailidis

Abstract: Despite intensive glucose-lowering treatment and advanced therapies for cardiovascular risk factors, such as hypertension and dyslipidaemia, diabetes mellitus with its macro- and microvascular complications remains a major health problem. Especially diabetic nephropathy is a leading cause of morbidity and mortality, and its prevalence is increasing. Peroxisome proliferator-activated receptor-α (PPAR-α), a member of a large nuclear receptor superfamily, is expressed in several tissues including the kidney. Recently, experimental data have suggested that PPAR-α activation plays a pivotal role in the regulation of fatty acid oxidation, lipid metabolism, inflammatory and vascular responses, and might regulate various metabolic and intracellular signalling pathways that lead to diabetic microvascular complications. This review examines the role of PPAR-α activation in diabetic nephropathy and summarises data from experimental and clinical studies on the emerging therapeutic potential of fibrates in diabetic nephropathy.

Effect of beta blocker therapy on survival of patients with heart failure and preserved systolic function following hospitalization with acute decompensated heart failure

European j internal medicine
Effect of beta blocker therapy on survival of patients with heart failure and preserved systolic function following hospitalization with acute decompensated heart failure
Roman Nevzorov, Avi Porath, Yaakov Henkin, Sergio L. Kobal, Alan Jotkowitz, Victor Novack on May 5, 2012 10:39 AM
Abstract: Background: The importance of heart failure with preserved ejection fraction is being increasingly recognized. However, there is a paucity of data about effective treatment for this condition. The present study investigated the impact of beta blocker therapy for 3months before admission on the two-year survival of patients with heart failure and preserved systolic function hospitalized due to decompensated heart failure.Methods: We performed a retrospective cohort analysis of 345 consecutive patients with heart failure with preserved systolic function older than 18years hospitalized due to decompensated heart failure. Two groups of patients were compared: those who received beta blockers within 3months before admission (BB) and those who did not (NBB). The primary outcome was two year all cause mortality (maximal follow-up available in all subjects). To adjust for a potential misbalance between BB and NBB groups in baseline characteristics, a propensity score for beta blocker therapy was incorporated into the survival model.Results: 154 patients (44.6%) received beta blockers prior to admission. Overall two year mortality rate in the BB group was 50% vs. 62.8% in the NBB group, log-rank test p=0.016. Beta blockers showed protective effect on two-year survival after adjustment for comorbidities and propensity score (hazard ratio [HR], 0.69; 95% CI 0.47–0.99).Conclusions: Therapy with beta blockers may have protective effect on survival of patients with heart failure with preserved systolic function.

Caminar lo mas rápido posible prolonga la vida

Trotar alarga la vida
Un trote de una hora a la semana aumenta 6 años la esperanza de vida. Datos presentados en el congreso EuroPrevent 2012, impulsado por la Sociedad Europea de Cardiología, y que tiene lugar estos días en Dublín
Una carrera de una o dos horas a la semana aumenta la esperanza de vida en 6,2 años en hombres y en 5,6 años en mujeres, según los últimos datos del estudio 'Copenhagen City Heart', presentado en el congreso EuroPrevent 2012, impulsado por la Sociedad Europea de Cardiología, y que tiene lugar estos días en Dublín.

"Podemos afirmar con total seguridad que la carrera, practicada con asiduidad, aumenta la longevidad. El aspecto positivo es que no es necesario demasiado esfuerzo para observar un claro beneficio", ha asegurado el autor principal del estudio 'Copenhagen City Heart', Peter Schnohr.

Así, este experto explica que con una carrera a ritmo suave o intermedio "hasta quedarse ligeramente sin aliento" de una hora a dos horas y media a la semana se consigue un beneficio óptimo para la longevidad.

El estudio Copenhagen City Heart, iniciado en 1976, observa a 20.000 hombres y mujeres de entre 20 y 93 años de edad con el fin de obtener un mayor conocimiento sobre la prevención de las enfermedades cardiovasculares y del íctus.

Desde entonces, el estudio, que ha servido para publicar más de 750 artículos, se ha ampliado para incluir otras enfermedades como la insuficiencia cardíaca, enfermedades pulmonares, alergias, epilepsia, demencia, apnea del sueño y enfermedades genéticas.

Los resultados muestran que, en el período de seguimiento (un máximo de 35 años) se registraron 10.158 muertes entre los individuos que no practicaban carrera y 122 muertes entre los que sí lo hacían.

El análisis mostró además que el riesgo de fallecimiento se redujo en un 44 por ciento para los corredores varones y también en un 44 por ciento para las mujeres.

"La mortalidad es menor en personas que realizan una carrera moderada, que en gente que no corre o en aquellos que practican el ejercicio de manera exagerada", ha señalado este autor, quien ha resaltado que la carrera facilita la captación de oxígeno, aumenta la sensibilidad a la insulina, mejora los perfiles lipídicos, desciende la presión sanguínea, reduce la agregación plaquetaria y eleva la actividad fibrinolítica.

Impact of Statin Therapy on Late Target Lesion Revascularization After Sirolimus-Eluting Stent Implantation (from the CREDO-Kyoto Registry Cohort-2)

American Journal of Cardiology
Volume 109, Issue 10 , Pages 1387-1396, 15 May 2012

Masahiro Natsuaki, MD, Yoshihisa Nakagawa, MD, Takeshi Morimoto, MD, Koh Ono, MD, Satoshi Shizuta, MD, Yutaka Furukawa, MD, Kazushige Kadota, MD, Masashi Iwabuchi, MD, Yoshihiro Kato, MD, Satoru Suwa, MD, Tsukasa Inada, MD, Osamu Doi, MD, Akinori Takizawa, MD, Masakiyo Nobuyoshi, MD, Toru Kita, MD, Takeshi Kimura, MD, CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators
Therapeutic strategies preventing late target lesion revascularization (TLR) after drug-eluting stent implantation have not been yet adequately investigated. In 13,087 consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs) only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index hospitalization on early (within the first year) and late (1 year to 4 years) TLR, was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly lower incidence of early TLR (7.8% vs 22.2%, p <0.0001), SES use compared to BMS use was associated with a significantly higher incidence of late TLR (7.7% vs 3.0%, p <0.0001). In the SES and BMS strata, the incidence of early TLR was similar regardless of statin use. In the SES stratum, the incidence of late TLR was significantly lower in the statin group than in the nonstatin group (6.1% vs 9.6%, p = 0.002), whereas no significant difference was found in the BMS stratum (2.6% vs 3.3%, p = 0.38). After adjusting confounders, risk for late TLR significantly favored statin use in the SES stratum (hazard ratio 0.73, 95% confidence interval 0.54 to 0.98, p = 0.04), whereas the risk decrease was not significant in the BMS stratum (hazard ratio 0.74, 95% confidence interval 0.46 to 1.20, p = 0.23). In conclusion, statin therapy at hospital discharge was associated with a significantly lower risk for late TLR after SES implantation.