Large Scale, Multifactorial Studies of Risk Factors
Risk factor prevalence and any therapeutic and lifestyle alterations that had been undertaken by patients aged seventy or less in nine European countries were compared over two five year spans, in the EUROASPIRE I and EUROASPIRE II study (Kotseva, Wood, DeBacket et al 2001). Unlike the case in the US, smoking levels in Europe failed to decline, but as in the US, obesity significantly increased. The taking of aspirin, thiazides, ACE inhibitors, and beta-blockers as cardioprotective strategies increased, but overall these improvements did not offset persistent adverse lifestyle trends in terms of blood pressure and blood chemistry. A EUROASPIRE III update (Kotseva, Wood, DeBacker et al 2009) disclosed that prescriptions taken to reduce high blood pressure and adverse lipid profiles increased significantly, but still brought levels down to acceptable levels in only half the case. Furthermore diabetes prevalence actually increased.
The INTERHEART study (Yussuf, Hawken, Ounpuu et al 2004) examined 52 countries, including some from every continent. It demonstrated that the same risk factors (particularly an increase in obesity and in smoking) leading to cardiovascular disease and death that applied in economically prosperous portions of the US and Western Europe, existed in both countries with emerging economies (People’s Republic of China) and Third World states in economic dire straits (Bangladesh) across the globe.
The SCORE project (Conroy, Pyorala , Fitzgerald et al., 2003), which analyzed the factors contributing to the cardiac-related deaths of 5652 patients out of a population sample of 200,000 Europeans, canonized the notion that number of years of duration of a risk factor (five years of being 40 lbs. overweight) , rather than just simply having a risk factor checked off (40 lbs. overweight today) , was a significantly better predictor of those who would die within a ten-year span.
Specific Risk Factors: Metabolic Syndrome & Diabetes
A strategic approach to combating a complex condition that encompasses adult onset diabetes and that typically involves obesity with abdominal fat concentration leading to hypertension, coronary artery disease and a propensity toward strokes was formalized under the term “Metabolic Syndrome ‘ (Alberti, Zimmer and Shaw 2006) and prevention guidelines increasingly took this pre-diabetic/pre-cardiovascular disease syndrome into consideration (Ruyden, Standl, Bartnik et al 2007). Indeed, diabetes was identified as the greatest single factor predisposing a patient to atherosclerosis, and since most diabetics actually die from complications of atherosclerosis, rather than from the diabetes itself, early and aggressive intervention with the aims of reducing lower density (LdL) cholesterol and triglyceride levels to stave off heart attacks was forcefully recommended (Beckman, Creager & Libby, 2002). In 2008 (Willer, Sanner, Jackson et al.) an even stronger genetic basis that underlies both predisposition to diabetes and higher concentrations of the bad heart-disease-contributing LdL was uncovered via an analysis of almost 18,000 persons with both conditions.
However, a more intense effort to manage insulin and glucose levels after a heart attack, did not seem to lengthen lives as compared to the standard metabolic monitoring (Malmberg, Ryden, Wedel et al 2005). However, advantages may still be realized from an aggressive approach in terms of reduced microvascular damage particularly in the kidneys and retinas (Skyler, Bergenstal, Bonow et al 2009).
Other Risk Factors:
High Blood Pressure, Sleep Apnea, Kidney Disease, Peripheral Artery Disease
In 2003, guidelines for what constitutes high blood pressure that predisposes to elevated risk of cardiovascular disease, particularly in patients 50 and older, were significantly revised downward, suggesting that many more Americans were at risk than was formerly thought (Chobanian, Bakris, Black et al.)
Sleep apnea, particularly the obstructive type common among the obese and especially among those with metabolic syndrome, has now now officially been designated another clear warning sign of rising risk for heart attack and stroke (Somers, White, Amin et al 2008).
Kidney disease was not far behind in statements on both predisposition and the need for proactive treatment (Sarnak, Levey, Schoolwerth et al 2003). Fowkes, Murray, Butcher et al (2008) and Smith, Allen, Blair et al ( 2006) added peripheral artery disease and blocked carotids to more generalized atherosclerosis as indicators for stepped up preventive therapy. Patients receiving cancer chemotherapy or suffering from certain immune disorders became a recognized class of at-cardiac-risk patients, often placed in that situation because drugs used for these conditions impaired heart function (Yeh 2006).
Preventive Measures: Exercise and Omega-3 Fatty Acids
A consensus recommendation for adults 18-65 from cardiologists, exercise physiologists and strength and conditioning trainers for 3-5 days of moderately energetic walking for 30 minutes or aerobics workouts lasting as little as 20 minutes per session emerged as an effective lifestyle strategy to decrease significantly the chance of heart attack and stroke (Haskell, Lee, Pale et al 2007). Another consensus finding was that the increased consumption of omega-3 fatty acids (classically available in oily fish, but now widely available in foods engineered for it such as omega-3 eggs and assorted supplements) seems to decrease in a small but a statistically significant way the mortality and admissions of hospital of patients who already had heart failure ( Tavazzi, Maggioni, Marchioli et al 2008).
The Drive for Evidence-Based Medicine Affects Cardiology Advice
Members of the American Heart Association and the American College of Cardiology have undertaken a thorough review of how many of their 7196 recommendations are based on hard science, and how many are based on well-meaning, ad hoc expert opinion issued in the absence of more rigorous studies, with the goal of increasing the proportion based on the latter (Tricoci, Allen, Kramer et al, 2009).
Heart Failure: The Knife Edge Balance of Good & Bad Inflammation
Heart failure, usually beginning after an infarct, is a progressive, downwardly spiraling disease, and a call for creative flexibility in treatment and deeper insight through basic research was issued (Hunt, Baker, Chin et al 2001). Cohn, Ferrari and Sharpe et al, 2000, had identified the heart’s unassisted and sometimes inept attempt at repairing the damaged areas, a process ironically benignly termed “remodeling” as the main culprit. Frangogiannis, Anderson, Benjamin et al (2002) provided an excellent explanation of why bypass surgery and related artery clearing surgeries work better: A paradoxically beneficial inflammatory response is triggered by the surgery, setting off a cascade of immune responses that ultimately promote the proliferation of fibroblasts and their subsequent conversion into well functioning cardiomyocytes, reducing the amount of necrotic or malfunctioning heart muscle that would be left by “remodeling” without intervention. Libby and Theroux (2005) however, demonstrated that ongoing inflammatory processes can lead to a proliferation of plaques elsewhere in the arterials system and that after addressing the initial blockages via bypass, medications that seek to stabilize other high-risk plaques in place, to prevent them from breaking free and causing another infarct, need to have the highest priority.
A Molecular Level Understanding of
Botched Attempts By the Heart to Repair Itself
& Handle Its Electrochemical Circuits
A key to modulating inflammation and enhancing the outcomes of the heart’s own repair attempts via reduced modeling appears to lay in a deeper understanding of the Matrix Metalloproteins (MMPs) and the enzymes that control them (Nagase, Visse and Murphy 2006). Sarbassov, Ali, Sengupta et al (2006) reported on the underlying mechanisms of a drug (rapamycin) often used in controlling cancer cells through regulating natural cell death (apoptosis) that increasingly serves a similar role in regulating the factors that lead to adverse cardiac remodeling.
Molecular genetic markers of heart disease, and ion channelpathies were finally introduced into a newly revised classification of heart diseases, a concession to contributions made using cardiac genomics, proteomics, and cellular level electrophysiology ( Maron, Towbin, Thiene et al 2006).
Comparing Medications to Reduce Blood Pressure
In a three way comparison (ALLHAT 2002) among blood-pressure lowering diuretics (typically thiazides) , Angiotensin-Converting Enzyme inhibitors (ACE inhibitors, e.g. lisinopril), and calcium channel blockers (Beta Blockers) among high-risk hypertensive patients, the thiazides were judged the best first choice for reasons of at least equal efficacy and significantly lower costs, although combination therapies were later to become the norm (Mancia, DeBacker, Dominiczak et al 2007).
In the Losaratan (Cozaar™) Intervention for Endpoint Reduction for Hypertension, best known as the LIFE trial, 8851 patients were monitored for onset on new cases of atrial fibrillation, with the longer-established comparison drug used for prevention and management, atenolol (Tenormin™) coming up on the short side.
ACE inhibitors (Yusuf, Sleight, Pogue et al 2000) and beta-blockers showed some early promise in forestalling inappropriate remodeling within the heart in damaged areas that leads to progressive heart failure (Cohn, Ferrari, Sharpre et al, 2000). ACE inhibitors and angiotensin receptor blockers (ARBs) appear to prevent atrial fibrillation, particularly in those patients who already have left ventricular dysfunction or hypertrophy (Healey, Baranchuk, Crystal et al 2005).
“Statin Island”
The use of a wide variety of competing statin (bad-cholesterol and triglyceride lowering) drugs vastly increased in this decade, but results favoring one over another were not always unambiguous. One of the most anticipated studies of competing drugs intended to lower LdL-C (the bad cholesterol) involved 8888 patients in northern Europe who had a previous heart attack. This IDEAL study (Pedersen, Faergeman,Kastelein et al 2005) demonstrated that high doses of atorvastatin (aka Lipitor™ ) did lower this bad cholesterol significantly better than simvastatin (aka Zocor™) and resulted in fewer subsequent nonfatal heart attacks, but there was ultimately no significant difference in death rates from either cardiac or non-cardiac causes. In another study, rosuvastatin (Crestor™) clearly lowered the adverse blood chemistry of patients in heart failure, but that it did not actually lifespan or hospital admission for cardiovascular reasons (Tavazzi, Maggioni, Marchiolo 2008).
Blood Thinners
In the blood thinning drug domain, Yusuf, Zhao, Meta et al (2001) report that the taking of a combination aspirin and other anti-coagulants, such as clopidogrel ( e.g. Plavix™) worked better than taking either one alone, particularly after any type of cardiac catheterization to avoid blood clots ( Steinhubl, Berger, Mann et al, 2002). The same group (Serebruanny, Steinhubl, Berger et al 2005) was later to develop a laboratory test for predicting which patients taking clopidogrel would underreact with insufficient blood thinning (about 4%) or overreact with excessively long clotting times (about 5%).
Avoiding Gastrointestinal Bleeding When on Blood Thinners
Nonetheless concern over limiting gastrointestinal side effects of combinations of aspiring and anticoagulants like clopidogrel have been investigated and the concurrent use of proton pump inhibitors (Prilosec™, Prevacid™) has now been strongly recommended (Bhatt, Scheiman, Abraham et al 2008).
Interventional Cardiology Using Catheterization
Atrial fibrillation was better controlled when a catheter, inserted via blood vessels in the groin and then threaded to heart, was used to sense and then burn misfiring centers within the heart (Nademanne, McKenzie, Kosar et al. 2004). Indeed, cardiac catheterization for a wide variety of pathologies had become so very widespread by the mid-2000s, that new and greatly enlarged guidelines had to be rewritten (Silber, Albertsson Aviles et al 2005, Silber, Albertsson, Blair et al 2006).
Cardiac Vessel Stents
The use of stents, coiled tubes placed via catheter, to keep open clogged coronary arteries also became commonplace in the early 2000s, particularly those which eluted drugs to control scarring or plaque build up, and promote healing (Woods and Marks 2004) . Nonetheless, controversies flared over whether plain or drug eluting stents were generally safer (Lagerqvist, James, Stenestrand et al 2007, Moreno, Fernandez, Hernandez et al 2005, Ong, McFadden, Regar et al 2005), and a call for standardization of clinical trials was issued (Cutlip, Windecker, Mehran et al 2007).
Autologous Transplantation of Heart Cells To Stimulate Cardiac Repair
Demonstrating that cardiac repair after a heart attack improves significantly when a plentiful supply of myoblasts is available, Menasche, Hagege, Vilquin et al provided patients with a transplant of their own myoblasts, derived from thigh biopsies that were further cultured in the lab, via injection into heart scar tissue. This procedure, while widely cited, has not yet become widespread.
The Cabbage (CABG) Patch
While less invasive procedures predominate today, the thoracic surgical management of heart disease , with Coronary Artery Bypass Graft Surgery, and valve replacement are still common and important procedures (Descoutures, Himbert, Lepage et al 2008, Smith, Allen, Blair et al 2006, Vahannian, Baumgartner, Bax et al 2007, Zeltsman and Acker 2002).
Pacemakers
The use of implanted devices (both the conventional implantable cardioverter and biventricular cardiac resynchronizers) grew almost exponentially in this decade (Matchett, Sears, Hazelton et al 2009, van Veldhuisen, Maass, Priori et al 2009) but the larger number of cases also disclosed some pitfalls, particularly in the durability of the wire leads (Haqqani and Mond 2009), but expert opinion remains optimistic about newer, electronically simplified models with greater ease of insertion and a single more durable lead (Santini, Cappato, Anfresen et al 2009).
Looking Into the Beating Heart
The most traditional of major instrumental measures of heart function, the echocardiogram, saw further standardization in terms of recommended uses and terminology (Lang, Bierig, Devereux et al 2005).
Leber, Knez, von Ziegler et al (2005) would eventually demonstrate the advantages of 64-slice computer tomography of the heart over ultrasonic techniques, and a generally upbeat assessment was provided in 2006 (Budoff, Achenbach, Blumenthal et al 2006). Nonetheless, Miller, Rochitte, Dewewy et al (2008) suggest that it is still essentially on a par with conventional coronary angiography, and owing to a few residual drawbacks, does not clearly replace it. Arad, Goodman, Roth et al (2005) showed that electron beam tomography, a further refinement, was even better for the determination of coronary calcification associated with atherosclerotic cardiovascular events, and had a higher predictive value than tests for C-Reactive Proteins, a common measure of the progression of this disease process. However, it was also determined that the Lifetime Risk Attributable (LAR) to any ionizing radiation (e.g. x-rays) during these probes was not negligible, particularly among those at risk of lung and breast cancer already (Einstein, Henzlova and Rajgopalan 2007). This was not an entirely unsurprising finding, and guidelines that recommended its continued use, with precautions, and that of an emerging technology at that time, cardiac magnetic resonance, which does not involve ionizing radiation, were issued in 2006 (Hendel, Patel, Kramer et al).
Non-Pedal P.A.D. – Peripheral Artery Disease
(This Time In the Arms Not in the Feet or Legs)
High-resolution brachial artery ultrasonic imaging for peripheral artery disease was regarded as particularly promising but only if carefully interpreted (Correti, Anderson, Benjamin et al 2002), and its adaptation as a model for clogged coronary arteries progressed (Mintz, Nissen Anderson et al, 2001).
Stroke
Guidelines for stroke prevention were drawn up in 2006 (Goldstein, Adams, Alberts et al). Guidelines for the management of strokes caused by arterial blockages in the brain in the first 48 hours were drawn up in 2007 (Adams, del Zoppo, Alberts et al).
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Adams,Harold P.,Jr, Gregory del Zoppo, Mark J. Alberts, Deepak L. Bhatt, Lawrence Brass, Anthony Furlan, Robert L. Grubb, et al. 2007. Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology And Intervention Council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups: The American Academy Of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke; a Journal of Cerebral Circulation 38, (5) (05): 1655-711.
Alberti, K. G. M. M., P. Zimmet, and J. Shaw. 2006. Metabolic syndrome--a new world-wide definition. A consensus statement from the international diabetes federation. Diabetic Medicine: A Journal of the British Diabetic Association 23, (5) (05): 469-80.
ALLHAT. 2002. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). 2002. JAMA: The Journal of the American Medical Association 288, (23) (12/18): 2981-97.
Alpert, J. S., E. Antman, F. Apple, P. W. Armstrong, J. P. Bassand, A. B. de Luna, G. Beller, et al. 2000. Myocardial infarction redefined - A consensus document of the joint European Society Of Cardiology/American College Of Cardiology committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology 36, (3) (SEP): 959-69.
Arad, Yadon, Kenneth J. Goodman, Marguerite Roth, David Newstein, and Alan D. Guerci. 2005. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: The St. Francis Heart Study. Journal of the American College of Cardiology 46, (1) (07/05): 158-65.
Bassand, Jean-Pierre, Christian W. Hamm, Diego Ardissino, Eric Boersma, Andrzej Budaj, Francisco Fernández-Avilés, Keith A. A. Fox, et al. 2007. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. European Heart Journal 28, (13) (07): 1598-660.
Beckman, J. A., M. A. Creager, and P. Libby. 2002. Diabetes and atherosclerosis - epidemiology, pathophysiology, and management. JAMA-Journal of the American Medical Association 287, (19) (MAY 15): 2570-81.
Bhatt, Deepak L., James Scheiman, Neena S. Abraham, Elliott M. Antman, Francis K. L. Chan, Curt D. Furberg, David A. Johnson, Kenneth W. Mahaffey, and Eamonn M. Quigley. 2008. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: A report of the American College Of Cardiology Foundation Task Force On Clinical Expert Consensus Documents. Circulation 118, (18) (10/28): 1894-909.
Braunwald, E., E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, et al. 2002. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2002: Summary article - A report of the American College Of Cardiology/American Heart Association Task Force On Practice Guidelines (Committee On The Management Of Patients With Unstable Angina). Circulation 106, (14) (OCT 1): 1893-900.
Budoff, Matthew J., Stephan Achenbach, Roger S. Blumenthal, J. J. Carr, Jonathan G. Goldin, Philip Greenland, Alan D. Guerci, et al. 2006. Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee On Cardiovascular Imaging And Intervention, Council On Cardiovascular Radiology And Intervention, and Committee On Cardiac Imaging, Council On Clinical Cardiology. Circulation 114, (16) (10/17): 1761-91.
Cerqueira, M. D., N. J. Weissman, V. Dilsizian, A. K. Jacobs, S. Kaul, W. K. Laskey, D. J. Pennell, et al. 2002. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart - A statement for healthcare professionals from the Cardiac Imaging Committee Of The Council On Clinical Cardiology Of The American Heart Association. Circulation 105, (4) (JAN 29): 539-42.
Cohn, J. N., R. Ferrari, N. Sharpe, and Int Forum Cardiac Remodeling. 2000. Cardiac remodeling-concepts and clinical implications: A consensus paper from an international forum on cardiac remodeling. Journal of the American College of Cardiology 35, (3) (MAR 1): 569-82.
Conroy, R. M., K. Pyorala, A. P. Fitzgerald, S. Sans, A. Menotti, G. De Backer, D. De Bacquer, et al. 2003. Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. European Heart Journal 24, (11) (JUN): 987-1003.
Corretti, M. C., T. J. Anderson, E. J. Benjamin, D. Celermajer, F. Charbonneau, M. A. Creager, J. Deanfield, et al. 2002. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery - A report of the International Brachial Artery Reactivity Task Force. Journal of the American College of Cardiology 39, (2) (JAN 16): 257-65.
Cutlip, Donald E., Stephan Windecker, Roxana Mehran, Ashley Boam, David J. Cohen, Gerrit-Anne van Es, P. G. Steg, et al. 2007. Clinical end points in coronary stent trials: A case for standardized definitions. Circulation 115, (17) (05/01): 2344-51.
Descoutures, Fleur, Dominique Himbert, Laurent Lepage, Bernard Iung, Delphine Détaint, Didier Tchetche, Eric Brochet, et al. 2008. Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly. European Heart Journal 29, (11) (06): 1410-7.
Einstein, Andrew J., Milena J. Henzlova, and Sanjay Rajagopalan. 2007. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA: The Journal of the American Medical Association 298, (3) (07/18): 317-23.
Fowkes, F. G. R., G. D. Murray, I. Butcher, C. L. Heald, R. J. Lee, L. E. Chambless, A. R. Folsom, et al. 2008. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: A meta-analysis. JAMA: The Journal of the American Medical Association 300, (2) (07/09): 197-208.
Frangogiannis, N. G., C. W. Smith, and M. L. Entman. 2002. The inflammatory response in myocardial infarction. Cardiovascular Research 53, (1) (JAN): 31-47.
Galiè, Nazzareno, Adam Torbicki, Robyn Barst, Philippe Dartevelle, Sheila Haworth, Tim Higenbottam, Horst Olschewski, et al. 2004. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force On Diagnosis And Treatment Of Pulmonary Arterial Hypertension Of The European Society Of Cardiology. European Heart Journal 25, (24) (12): 2243-78.
Goldstein, Larry B., Robert Adams, Mark J. Alberts, Lawrence J. Appel, Lawrence M. Brass, Cheryl D. Bushnell, Antonio Culebras, et al. 2006. Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the atherosclerotic peripheral vascular disease interdisciplinary working group; cardiovascular nursing council; clinical cardiology council; nutrition, physical activity, and metabolism council; and the Quality Of Care And Outcomes Research Interdisciplinary Working Group: The American Academy Of Neurology affirms the value of this guideline. Stroke; a Journal of Cerebral Circulation 37, (6) (06): 1583-633.
Gum, P. A., K. Kottke-Marchant, P. A. Welsh, J. White, and E. J. Topol. 2003. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. Journal of the American College of Cardiology 41, (6) (MAR 19): 961-5.
Haqqani, Haris M., and Harry G. Mond. 2009. The implantable cardioverter-defibrillator lead: Principles, progress, and promises. Pacing and Clinical Electrophysiology: PACE 32, (10) (10): 1336-53.
Haskell, William L., I-M Lee, Russell R. Pate, Kenneth E. Powell, Steven N. Blair, Barry A. Franklin, Caroline A. Macera, Gregory W. Heath, Paul D. Thompson, and Adrian Bauman. 2007. Physical activity and public health: Updated recommendation for adults from the American College Of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise 39, (8) (08): 1423-34.
Healey, Jeff S., Adrian Baranchuk, Eugene Crystal, Carlos A. Morillo, Michael Garfinkle, Salim Yusuf, and Stuart J. Connolly. 2005. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: A meta-analysis. Journal of the American College of Cardiology 45, (11) (06/07): 1832-9.
Hendel, Robert C., Manesh R. Patel, Christopher M. Kramer, Michael Poon, Robert C. Hendel, James C. Carr, Nancy A. Gerstad, et al. 2006. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: A report of the American College Of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College Of Radiology, Society Of Cardiovascular Computed Tomography, Society For Cardiovascular Magnetic Resonance, American Society Of Nuclear Cardiology, North American Society For Cardiac Imaging, Society For Cardiovascular Angiography And Interventions, and Society Of Interventional Radiology. Journal of the American College of Cardiology 48, (7) (10/03): 1475-97.
Hunt, S. A., D. W. Baker, M. H. Chin, M. P. Cinquegrani, A. M. Feldman, G. S. Francis, T. G. Ganiats, et al. 2001. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary - A report of the American College Of Cardiology/American Heart Association Task Force On Practice Guidelines (Committee To Revise The 1995 Guidelines For The Evaluation And Management Of Heart Failure). Circulation 104, (24) (DEC 11): 2996-3007.
Kotseva, K., D. Wood, G. De Backer, D. De Bacquer, K. Pyorala, U. Keil, and EUROASPIRE II Study Group. 2001. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries - Principal results from EUROASPIRE II Euro Heart Survey programme. European Heart Journal 22, (7) (APR): 554-72.
Kotseva, K., D. Wood, G. De Backer, D. De Bacquer, K. Pyorala, U. Keil, S. Sans, et al. 2001. Clinical reality of coronary prevention guidelines: A comparison of EUROASPIRE I and II in nine countries. Lancet 357, (9261) (MAR 31): 995-1001.
Kotseva, Kornelia, David Wood, Guy De Backer, Dirk De Bacquer, Kalevi Pyörälä, and Ulrich Keil. 2009. Cardiovascular prevention guidelines in daily practice: A comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 373, (9667) (03/14): 929-40.
Lagerqvist, Bo, Stefan K. James, Ulf Stenestrand, Johan Lindbäck, Tage Nilsson, and Lars Wallentin. 2007. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. The New England Journal of Medicine 356, (10) (03/08): 1009-19.
Lang, R. M., M. Bierig, R. B. Devereux, F. A. Flachskampf, E. Foster, P. A. Pellikka, M. H. Picard, et al. 2005. Recommendations for chamber quantification: A report from the American Society Of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association Of Echocardiography, a branch of the European Society Of Cardiology. Journal of the American Society of Echocardiography 18, (12) (DEC): 1440-63.
Leber, Alexander W., Andreas Knez, Franz von Ziegler, Alexander Becker, Konstantin Nikolaou, Stephan Paul, Bernd Wintersperger, et al. 2005. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: A comparative study with quantitative coronary angiography and intravascular ultrasound. Journal of the American College of Cardiology 46, (1) (07/05): 147-54.
Libby, Peter, and Pierre Theroux. 2005. Pathophysiology of coronary artery disease. Circulation 111, (25) (06/28): 3481-8.
Malmberg, K., L. Rydén, H. Wedel, K. Birkeland, A. Bootsma, K. Dickstein, S. Efendic, et al. 2005. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): Effects on mortality and morbidity. European Heart Journal 26, (7) (04): 650-61.
Mancia, G., E. A. Rosei, R. Cifkova, G. DeBacker, S. Erdine, R. Fagard, C. Farsang, et al. 2003. 2003 European Society Of Hypertension - European Society Of Cardiology guidelines for the management of arterial hypertension. Journal of Hypertension 21, (6) (JUN): 1011-53.
Mancia, Giuseppe, Guy De Backer, Anna Dominiczak, Renata Cifkova, Robert Fagard, Giuseppe Germano, Guido Grassi, et al. 2007. 2007 guidelines for the management of arterial hypertension: The Task Force For The Management Of Arterial Hypertension Of The European Society Of Hypertension (ESH) and of the European Society Of Cardiology (ESC). European Heart Journal 28, (12) (06): 1462-536.
Maron, Barry J., Jeffrey A. Towbin, Gaetano Thiene, Charles Antzelevitch, Domenico Corrado, Donna Arnett, Arthur J. Moss, Christine E. Seidman, and James B. Young. 2006. Contemporary definitions and classification of the cardiomyopathies: An American Heart Association scientific statement from the Council On Clinical Cardiology, Heart Failure And Transplantation Committee; Quality Of Care And Outcomes Research And Functional Genomics And Translational Biology Interdisciplinary Working Groups; and Council On Epidemiology And Prevention. Circulation 113, (14) (04/11): 1807-16.
Matchett, Melissa, Samuel F. Sears, Garrett Hazelton, Kari Kirian, Elynor Wilson, and Rajasekhar Nekkanti. 2009. The implantable cardioverter defibrillator: Its history, current psychological impact and future. Expert Review of Medical Devices 6, (1) (01): 43-50.
Menasche, P., A. A. Hagege, J. T. Vilquin, M. Desnos, E. Abergel, B. Pouzet, A. Bel, et al. 2003. Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. Journal of the American College of Cardiology 41, (7) (APR 2): 1078-83.
Miller, Julie M., Carlos E. Rochitte, Marc Dewey, Armin Arbab-Zadeh, Hiroyuki Niinuma, Ilan Gottlieb, Narinder Paul, et al. 2008. Diagnostic performance of coronary angiography by 64-row CT. The New England Journal of Medicine 359, (22) (11/27): 2324-36.
Mintz, G. S., S. E. Nissen, W. D. Anderson, S. R. Bailey, R. Erbel, P. J. Fitzgerald, F. J. Pinto, et al. 2001. American college of cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS) - A report of the American College Of Cardiology Task Force On Clinical Expert Consensus - Documents developed in collaboration with the European Society Of Cardiology endorsed by the Society Of Cardiac Angiography And Interventions. Journal of the American College of Cardiology 37, (5) (APR): 1478-92.
Moreno, Raúl, Cristina Fernández, Rosana Hernández, Fernando Alfonso, Dominick J. Angiolillo, Manel Sabaté, Javier Escaned, Camino Bañuelos, Antonio Fernández-Ortiz, and Carlos Macaya. 2005. Drug-eluting stent thrombosis: Results from a pooled analysis including 10 randomized studies. Journal of the American College of Cardiology 45, (6) (03/15): 954-9.
Nademanee, K., J. McKenzie, E. Kosar, M. Schwab, B. Sunsaneewitayakul, T. Vasavakul, C. Khunnawat, and T. Ngarmukos. 2004. A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. Journal of the American College of Cardiology 43, (11) (JUN 2): 2044-53.
Nagase, Hideaki, Robert Visse, and Gillian Murphy. 2006. Structure and function of matrix metalloproteinases and TIMPs. Cardiovascular Research 69, (3) (02/15): 562-73.
Ong, Andrew T. L., Eugène P. McFadden, Evelyn Regar, Peter de Jaegere P.T., Ron van Domburg T., and Patrick W. Serruys. 2005. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. Journal of the American College of Cardiology 45, (12) (06/21): 2088-92.
Pearson, T. A., S. N. Blair, S. R. Daniels, R. H. Eckel, J. M. Fair, S. P. Fortmann, B. A. Franklin, et al. 2002. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update - consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulation 106, (3) (JUL 16): 388-91.
Pedersen, Terje R., Ole Faergeman, John J. P. Kastelein, Anders G. Olsson, Matti J. Tikkanen, Ingar Holme, Mogens Lytken Larsen, et al. 2005. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: The IDEAL study: A randomized controlled trial. JAMA: The Journal of the American Medical Association 294, (19) (11/16): 2437-45.
Rydén, Lars, Eberhard Standl, Małgorzata Bartnik, den Berghe Van, John Betteridge, Menko-Jan de Boer, Francesco Cosentino, et al. 2007. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: Executive summary. The Task Force On Diabetes And Cardiovascular Diseases Of The European Society Of Cardiology (ESC) and of the European Association For The Study Of Diabetes (EASD). European Heart Journal 28, (1) (01): 88-136.
Santini, Massimo, Riccardo Cappato, Dietrich Andresen, Johannes Brachmann, D. W. Davies, John Cleland, Alessandro Filippi, et al. 2009. Current state of knowledge and experts' perspective on the subcutaneous implantable cardioverter-defibrillator. Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing 25, (1) (06): 83-8.
Sarbassov, Dos D., Siraj M. Ali, Shomit Sengupta, Joon-Ho Sheen, Peggy P. Hsu, Alex F. Bagley, Andrew L. Markhard, and David M. Sabatini. 2006. Prolonged rapamycin treatment inhibits mTORC2 assembly and Akt/PKB. Molecular Cell 22, (2) (04/21): 159-68.
Sarnak, M. J., A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, et al. 2003. Kidney disease as a risk factor for development of cardiovascular disease - A statement from the American Heart Association Councils On Kidney In Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, And Epidemiology And Prevention. Circulation 108, (17) (OCT 28): 2154-69.
Serebruany, Victor L., Steven R. Steinhubl, Peter B. Berger, Alex I. Malinin, Deepak L. Bhatt, and Eric J. Topol. 2005. Variability in platelet responsiveness to clopidogrel among 544 individuals. Journal of the American College of Cardiology 45, (2) (01/18): 246-51.
Silber, S., P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, et al. 2005. Guidelines for percutaneous coronary interventions - the task force for percutaneous coronary interventions of the European Society Of Cardiology. European Heart Journal 26, (8) (APR): 804-47.
Silber, Sigmund, Per Albertsson, Francisco Avilés F., Paolo G. Camici, Antonio Colombo, Christian Hamm, Erik Jørgensen, et al. 2005. Guidelines for percutaneous coronary interventions. the Task Force For Percutaneous Coronary Interventions Of The European Society Of Cardiology. European Heart Journal 26, (8) (04): 804-47.
Skyler, Jay S., Richard Bergenstal, Robert O. Bonow, John Buse, Prakash Deedwania, Edwin A. M. Gale, Barbara V. Howard, et al. 2009. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA diabetes trials: A position statement of the American Diabetes Association and a scientific statement of the American College Of Cardiology Foundation and the American Heart Association. Circulation 119, (2) (01/20): 351-7.
Smith, S. C., J. Allen, S. N. Blair, R. O. Bonow, L. M. Brass, G. C. Fonarow, S. M. Grundy, et al. 2006. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update - endorsed by the National Heart, Lung, and Blood Institute. Circulation 113, (19) (MAY 16): 2363-72.
Somers, Virend K., David P. White, Raouf Amin, William T. Abraham, Fernando Costa, Antonio Culebras, Stephen Daniels, et al. 2008. Sleep apnea and cardiovascular disease: An American Heart Association/American College Of Cardiology Foundation scientific statement from the American Heart Association Council For High Blood Pressure Research Professional Education Committee, Council On Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing, in collaboration with the National Heart, Lung, And Blood Institute National Center On Sleep Disorders Research (National Institutes Of Health). Circulation 118, (10) (09/02): 1080-111.
Steinhubl, Steven R., Peter B. Berger, J. T. Mann, Edward T. A. Fry, Augustin DeLago, Charles Wilmer, and Eric J. Topol. 2002. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: A randomized controlled trial. JAMA: The Journal of the American Medical Association 288, (19) (11/20): 2411-20.
Tavazzi, Luigi, Aldo P. Maggioni, Roberto Marchioli, Simona Barlera, Maria Grazia Franzosi, Roberto Latini, Donata Lucci, Gian Luigi Nicolosi, Maurizio Porcu, and Gianni Tognoni. 2008. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial. Lancet 372, (9645) (10/04): 1223-30.
Tavazzi, Luigi, Aldo P. Maggioni, Roberto Marchioli, Simona Barlera, Maria Grazia Franzosi, Roberto Latini, Donata Lucci, Gian Luigi Nicolosi, Maurizio Porcu, and Gianni Tognoni.. 2008. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial. Lancet 372, (9645) (10/04): 1231-9.
Tricoci, Pierluigi, Joseph M. Allen, Judith M. Kramer, Robert M. Califf, and Smith,Sidney C.,,Jr. 2009. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA: The Journal of the American Medical Association 301, (8) (02/25): 831-41.
Vahanian, Alec, Helmut Baumgartner, Jeroen Bax, Eric Butchart, Robert Dion, Gerasimos Filippatos, Frank Flachskampf, et al. 2007. Guidelines on the management of valvular heart disease: The Task Force On The Management Of Valvular Heart Disease Of The European Society Of Cardiology. European Heart Journal 28, (2) (01): 230-68.
van Veldhuisen, Dirk,J., Alexander H. Maass, Silvia G. Priori, Pelle Stolt, Isabelle van Gelder C., Kenneth Dickstein, and Karl Swedberg. 2009. Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: Changes from 2004 to 2008. European Journal of Heart Failure: Journal of the Working Group on Heart Failure of the European Society of Cardiology 11, (12) (12): 1143-51.
Wachtell, Kristian, Mika Lehto, Eva Gerdts, Michael H. Olsen, Björn Hornestam, Björn Dahlöf, Hans Ibsen, et al. 2005. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: The Losartan intervention for end point reduction in hypertension (LIFE) study. Journal of the American College of Cardiology 45, (5) (03/01): 712-9.
Willer, Cristen J., Serena Sanna, Anne U. Jackson, Angelo Scuteri, Lori L. Bonnycastle, Robert Clarke, Simon C. Heath, et al. 2008. Newly identified loci that influence lipid concentrations and risk of coronary artery disease. Nature Genetics 40, (2) (02): 161-9.
Woods, T. C., and Andrew R. Marks. 2004. Drug-eluting stents. Annual Review of Medicine 55, (1) (02/01): 169-78.
Yeh, Edward T. H. 2006. Cardiotoxicity induced by chemotherapy and antibody therapy. Annual Review of Medicine 57, (1) (02/01): 485-98.
Yusuf, S., P. Sleight, J. Pogue, J. Bosch, R. Davies, and G. Dagenais. 2000. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. The New England Journal of Medicine 342, (3) (01/20): 145-53.
Yusuf, S., F. Zhao, S. R. Mehta, S. Chrolavicius, G. Tognoni, and K. K. Fox. 2001. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. The New England Journal of Medicine 345, (7) (08/16): 494-502.
Yusuf, Salim, Steven Hawken, Stephanie Ounpuu, Tony Dans, Alvaro Avezum, Fernando Lanas, Matthew McQueen, et al. 2004. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 364, (9438) (09/11): 937-52.
Zeltsman, David, and Michael A. Acker. 2002. Surgical management of heart failure: An overview. Annual Review of Medicine 53, (1) (02/01): 383-91.
Thanks for the info. Anywhere else I can find more information on aortic valve replacement?
Posted by: Aortic Valve Replacement | July 29, 2011 at 01:35 PM
Veins carry blood from the body back to the heart, and have one-way valves that prevent blood from flowing backward. If the valves become weakened, some blood can remain in the vein, causing the vein to enlarge and bulge. Larger congested veins found mostly in the legs are commonly called varicose veins.
Posted by: Heart and Vein Center | June 19, 2011 at 06:42 PM
Heart disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels (arteries and veins).Thank you so much for the wealth of information.
mjd
Posted by: cardiology emr | June 16, 2010 at 10:25 PM