Journal of Hypertension, 11/19/2012 Clinical Article
Low–quality evidence did not show any statistically significant effect of coffee consumption on BP or the risk of hypertension. Given the quality of the currently available evidence, no recommendation can be made for or against coffee consumption as it relates to BP and hypertension
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Lipid-lowering therapy and coronary artery bypass graft surgery: what are the benefits?
Current Opinion in Cardiology, 10/25/2011 Clinical Article
Kulik A et al. – Statins clearly improve the outcomes of CABG patients. In the absence of contraindications, all patients undergoing CABG are candidates for life–long statin therapy, with initiation recommended as soon as coronary disease is documented. Statins should be restarted early after surgery. However, the optimal postoperative lipid–lowering regimen remains unknown and should be the subject of upcoming trials. Strategies directed toward improving statin prescription rates and patient adherence should also be priorities for future research.
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Despite their apparent benefits, statins remain underutilized after coronary artery bypass graft (CABG) surgery.
To summarize the literature regarding statin therapy and CABG, authors performed a systematic review of the Medline database from 1987–2011 to assess the benefits of statins in CABG patients, including the role of high–dose therapy, and highlight areas for future study.
When administered prior to CABG, statins reduce the risk of read more
Chocolate and Coronary Heart Disease: A Systematic Review
Current Atherosclerosis Reports, 09/13/2011
Khawaja O et al. – This article reviews current evidence on the effects of cocoa/chocolate on clinical and subclinical coronary heart disease (CHD), CHD risk factors, and potential biologic mechanisms. It also discusses major limitations of currently available data and future directions in the field...read more
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Long-term effects of weight-reducing diets in hypertensive patients
Cochrane Reviews, 09/12/2011 Clinical Article
Siebenhofer A et al. - In patients with primary hypertension, weight loss diets reduced body weight and blood pressure, however the magnitude of the effects are uncertain as a result of the small number of patients and studies that could be included in the analyses. It is not known whether weight loss reduces mortality and morbidity. No useful information on adverse effects was reported in the relevant trials.
- Studies were obtained from computerised searches of Ovid MEDLINE, EMBASE, CENTRAL and from searches in reference lists and systematic reviews.
- Randomised controlled trials (RCT) in adult hypertensive patients were included if they had a study duration of at least 24 weeks and compared weight reducing dietary interventions to no dietary intervention in adult patients with primary hypertension.
- Two authors independently assessed risk of bias and extracted data.
- Studies were pooled using fixed-effect meta-analysis.
- In case of moderate or larger heterogeneity as measured by Higgins I2, a random effects model was used...read more
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16-Year Trends in the Infection Burden for Pacemakers and Implantable Cardioverter-Defibrillators in the United States
JACC - Journal of the American College of Cardiology, 09/08/2011
Greenspon AJ et al. – The infection burden associated with cardiac implantable electrophysiological device (CIED) implantation is increasing over time and is associated with prolonged hospital stays and high financial costs.
- The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD–9–CM).
- CIED infection was defined as either:
- ICD–9 code for device–related infection (996.61) and any CIED procedure or removal code;
- Or CIED procedure code along with systemic infection.
- Patient health profile was evaluated by coding for renal failure, heart failure, respiratory failure, and diabetes mellitus.
- The infection burden and patient health profile were calculated for each year, and linear regression was used to test for changes over time.
- During the study period (1993 to 2008), the incidence of CIED infection was 1.61%.
- The annual rate of ...read more
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Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox
Mayo Clinic Proceedings, 08/31/2011 Clinical Article
Lavie CJ et al. - Although both low BF and low body mass index (BMI) are independent predictors of mortality in patients with coronary heart disease (CHD), only patients with combined low body fat (BF)/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition in the secondary prevention of CHD.
- The authors studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided into low (<25) and high BMI (≥25), as well as low (≤25% men and ≤35% women) and high BF (>25% in men and >35% in women).
- Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311).
- During the 3-year follow-up, mortality was highest in the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, respectively); using the high BF/high BMI group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (confidence interval [CI], 1.76-10.23; P=.001).
- In multivariate logistic regression for mortality, when entered individually, both high BMI (odds ratio [OR], 0.79; CI, 0.69-0.90) and read more
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Vitamin D Deficiency, Adiposity, and Cardiometabolic Risk in Urban Schoolchildren
The Journal of Pediatrics, 08/15/2011
Sacheck J et al. – Vitamin D deficiency is highly prevalent during the late winter months in urban schoolchildren living in the northeastern United States. This widespread deficiency may contribute to the lack of associations between 25(OH)D and both BMIz and cardiometabolic risk factors. The association between 25–hydroxyvitamin D [25(OH)D] and CRP warrants further study.
- The authors assessed the relationships among serum 25–hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z–score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high–density lipoprotein cholesterol, low–density lipoprotein cholesterol, triglycerides, interleukin–6, and C–reactive protein [CRP]) in a cross–sectional sample of 263 racially and ethnically diverse schoolchildren from the Boston area during late winter.
- Multivariate regression analyses adjusting for sociodemographic characteristics and BMIz examined associations of 25(OH)D and cardiometabolic risk factors.
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Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery
Journal of Nuclear Cardiology, 07/18/2011
Gemignani AS et al. – In a typical pre–bariatric surgery population, the incidence of abnormal stress MPI is low. The majority of patients were able to use a stress–only strategy for assessment of perfusion. At 1 year the incidence of adverse cardiovascular outcomes is very low. Additional studies should be focused on determining whether any subgroup of such patients may benefit more from pre–operative stress testing.
- Authors retrospectively reviewed a series of 383 consecutive stress MPI studies performed on patients undergoing workup prior to planned bariatric surgery.
- The study population had a mean age 42 ± 10 years, and was 83% female, with a body mass index of 49 ± 8.
- The majority of patients (81%) were able to exercise using either the Bruce or Modified Bruce protocol, and 67% underwent stress–only imaging.
- Overall SPECT MPI findings were ...read more
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Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy: A Meta-analysis
JAMA, 06/24/2011 Evidence Based Medicine Clinical Article
Preiss D et al. - In a pooled analysis of data from 5 statin trials, intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy.
- The authors identified relevant trials in a literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (January 1, 1996, through March 31, 2011).
- Unpublished data were obtained from investigators.
- The authors included randomized controlled end-point trials that compared intensive-dose statin therapy with moderate-dose statin therapy and included more than 1000 participants who were followed up for more than 1 year.
- Tabular data provided for each trial described baseline characteristics and numbers of participants developing diabetes and experiencing major cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke, coronary revascularization).
- The authors calculated trial-specific odds ratios (ORs) for new-onset diabetes and major cardiovascular events and combined these using random-effects model meta-analysis.
- Between-study heterogeneity was assessed using the I2 statistic.
- In 5 statin trials with 32 752 participants without diabetes at baseline, 2749 developed ...read more