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Source: The American Journal of Medicine

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Total 259 results found since Jan 2013.

NSAID Use and Association with Cardiovascular Outcomes in Outpatients with Stable Atherothrombotic Disease
Abstract: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of...
Source: The American Journal of Medicine - November 25, 2013 Category: Journals (General) Authors: Payal Kohli, Ph. Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E. Magnus Ohman, Mark J. Alberts, Elaine Hoffman, Jianping Guo, Tabassome Simon, Emmanuel Sorbets, Shinya Goto, Deepak L. Bhatt, REACH Registry Investigators Tags: Clinical research studies Source Type: research

The Reply
Intracranial bleeding with thrombolytic therapy in elderly patients with pulmonary embolism is far less frequent than death if unstable and thrombolytic therapy is withheld (42.6% mortality if untreated, aged 61-70, and no comorbid conditions vs 9.3% mortality with thrombolytic therapy; 47.0% mortality with comorbid conditions if untreated vs 21.6% if treated). In patients>65 years or with kidney disease, intracranial hemorrhage occurred in 1.4% with thrombolytic therapy. Intracranial hemorrhage with thrombolytic therapy in elderly patients with acute myocardial infarction also occurred in 1.4%. With ≥ 5 risk factors for...
Source: The American Journal of Medicine - October 22, 2013 Category: Journals (General) Authors: Paul D. Stein, Fadi Matta Tags: Letters Source Type: research

Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?
Abstract: Background: Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of
Source: The American Journal of Medicine - October 18, 2013 Category: Journals (General) Authors: JoEllyn M. Abraham, Joseph Larson, Mina K. Chung, Anne B. Curtis, Kamakshi Lakshminarayan, Jonathan D. Newman, Marco Perez, Kathryn Rexrode, Nawar M. Shara, Allen J. Solomon, Marcia L. Stefanick, James C. Torner, Bruce L. Wilkoff, Sylvia Wassertheil-Smoll Tags: Clinical research studies Source Type: research

Venous and Arterial Viscosity-associated Thrombosis in Hemoglobin SC Disease
I read with interest the article of Naik et al highlighting the risk of venous thrombosis in patients suffering from sickle cell disease. However, the authors may have missed the opportunity to address an important issue by studying separately sickle cell anemia and hemoglobin SC patients whose clinical presentation, pathogenesis, treatment and evolution are quite different. Hemoglobin SC patients usually are not anemic or only mildly anemic, and hyperviscosity plays a key role in the pathogenesis of complications observed in this disease. We showed in a recent study that life-threatening complication observed in hemoglo...
Source: The American Journal of Medicine - September 25, 2013 Category: Journals (General) Authors: François Lionnet Tags: Letters Source Type: research

Risk Factors for Aspiration in Community-acquired Pneumonia: Analysis of a Hospitalized UK Cohort
Abstract: Background: There is a move toward finding clinically useful “phenotypes” in community-acquired pneumonia: groups of patients displaying distinct clinical characteristics, microbiology, and prognosis. Aspiration pneumonia is an intuitive clinical phenotype; however, to date there are no recognized diagnostic criteria, and data regarding outcomes in suspected aspiration are limited.Methods: An observational study of 1348 patients hospitalized with community-acquired pneumonia in the United Kingdom examined both short- and long-term outcomes for patients at risk of aspiration pneumonia. Patients were defined as...
Source: The American Journal of Medicine - September 19, 2013 Category: Journals (General) Authors: Joanne K. Taylor, Gillian B. Fleming, Aran Singanayagam, Adam T. Hill, James D. Chalmers Tags: Clinical research studies Source Type: research

Cardiovascular Risk in Rheumatoid Arthritis: Comparing TNF-α Blockade with Nonbiologic DMARDs
Conclusion: Among subjects with rheumatoid arthritis, TNF-α blocking agents may be associated with a reduced risk of cardiovascular events compared with an nbDMARD. Randomized controlled clinical trials should be considered to test this hypothesis.
Source: The American Journal of Medicine - July 26, 2013 Category: Journals (General) Authors: Daniel H. Solomon, Jeffrey R. Curtis, Kenneth G. Saag, Joyce Lii, Lang Chen, Leslie R. Harrold, Lisa J. Herrinton, David J. Graham, Mary K. Kowal, Bindee Kuriya, Liyan Liu, Marie R. Griffin, James D. Lewis, Jeremy A. Rassen Tags: Clinical research studies Source Type: research

The Assassin: Chagas Cardiomyopathy
A 35-year-old Salvadoran woman had been hospitalized for heart failure multiple times over a 5-year period, yet the etiology of her disease remained elusive. She also had a history of stroke. Again, she presented to the emergency department with shortness of breath, chest pain, and fatigue. Although these symptoms were chronic, they had been increasing for 3 weeks prior to admission. The patient denied fevers, chills, cough, or gastrointestinal complaints. She had no history of smoking, alcohol consumption, or illicit drug use. Her medications included carvedilol, furosemide, and warfarin.
Source: The American Journal of Medicine - July 19, 2013 Category: Journals (General) Authors: Uppinder K. Mattu, Gagan D. Singh, Jeffrey A. Southard, Ezra A. Amsterdam Tags: Diagnostic dilemma Source Type: research

Adherence to Secondary Prevention Medications and Four-year Outcomes in Outpatients with Atherosclerosis
Abstract: Background: Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry.Methods: Adherence with these medications in eligible patients a...
Source: The American Journal of Medicine - June 24, 2013 Category: Journals (General) Authors: Dharam J. Kumbhani, Ph. Gabriel Steg, Christopher P. Cannon, Kim A. Eagle, Sidney C. Smith, Elaine Hoffman, Shinya Goto, E. Magnus Ohman, Deepak L. Bhatt, REduction of Atherothrombosis for Continued Health Registry Investigators Tags: Clinical research studies Source Type: research

Emerging Clinical Challenges in the Use of Statins
In randomized trials and meta-analyses, statins decrease myocardial infarction, stroke, vascular death, and total mortality. The totality of evidence indicates no threshold below which there are no net benefits, including primary prevention subjects at low risk. In this commentary, we present some consequent new and emerging clinical challenges.
Source: The American Journal of Medicine - June 19, 2013 Category: Journals (General) Authors: Charles H. Hennekens, Nicolas R. Breuer, Ira J. Gelb, David J. Bjorkman, Jeffrey S. Borer, Marc A. Pfeffer Tags: Commentary Source Type: research

Body Mass Index and Adverse Events in Patients with Incident Atrial Fibrillation
Abstract: Background: Obesity is associated with the development of atrial fibrillation and may impact atrial fibrillation-related outcomes. To date, no anthropometric measure is included in any risk stratification scheme for stroke and death in atrial fibrillation patients.Methods: The prospective Danish Diet, Cancer and Health study is a cohort including 57,053 participants (27,178 men and 29,875 women) aged between 50 and 64 years. The study population for this study included the 3135 patients (2025 men and 1110 women) who developed incident atrial fibrillation during follow-up.Results: Of the subjects with atrial fibri...
Source: The American Journal of Medicine - April 18, 2013 Category: Journals (General) Authors: Thure Filskov Overvad, Lars Hvilsted Rasmussen, Flemming Skjøth, Kim Overvad, Gregory Y.H. Lip, Torben Bjerregaard Larsen Tags: Clinical research studies Source Type: research

Impact of Severe Mitral Regurgitation on Postoperative Outcomes After Noncardiac Surgery
Abstract: Objective: Preoperative cardiac risk assessment scoring systems traditionally do not include valvular regurgitation as a criterion for adverse outcome prediction. We sought to determine the impact of significant mitral regurgitation on postoperative outcomes after planned noncardiac surgeries. Methods: Patients with significant mitral regurgitation (moderate-severe or severe) undergoing noncardiac surgery were identified using surgical and echocardiographic databases at the Cleveland Clinic. The mechanism of mitral regurgitation was identified and classified as ischemic or nonischemic. By using propensity sco...
Source: The American Journal of Medicine - April 15, 2013 Category: Journals (General) Authors: Navkaranbir S. Bajaj, Shikhar Agarwal, Anitha Rajamanickam, Akhil Parashar, Kanhaiya Lal Poddar, Brian P. Griffin, Thadeo Catacutan, E. Murat Tuzcu, Samir R. Kapadia Tags: Clinical research studies Source Type: research

Aspirin in the Treatment and Prevention of Cardiovascular Disease: Past and Current Perspectives and Future Directions
Abstract: In secondary prevention among a wide range of patients who have survived a prior occlusive vascular event, as well as during acute myocardial infarction and acute occlusive stroke, aspirin produces statistically significant and clinically important reductions in the risk of subsequent myocardial infarction, stroke, and vascular death. In primary prevention, aspirin reduces risk of a first myocardial infarction, but the data on stroke and vascular deaths remain inconclusive. In addition, the average absolute risk of subjects randomized in the primary prevention trials was so low that it is not possible to get rel...
Source: The American Journal of Medicine - March 15, 2013 Category: Journals (General) Authors: Charles H. Hennekens, James E. Dalen Tags: Reviews Source Type: research

Acute Stroke Imaging: What Clinicians Need to Know
Abstract: Advances in technology and software applications have contributed to new imaging modalities and strategies in the evaluation of patients with suspected acute cerebral infarction. Routine computed tomography (CT) and magnetic resonance imaging (MRI) have been the standard studies in stroke imaging, which have been complemented by CT and MR angiography, diffusion-weighted MR imaging, and cerebral perfusion studies, while conventional angiography is typically reserved for intra-arterial therapy. The purpose of this article is to review the variety of imaging studies available in the acute stroke setting, and to dis...
Source: The American Journal of Medicine - March 15, 2013 Category: Journals (General) Authors: Rihan Khan, Kambiz Nael, William Erly Tags: Reviews Source Type: research

Functional Disability, Cognitive Impairment, and Depression After Hospitalization for Pneumonia
Conclusions: Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.
Source: The American Journal of Medicine - March 15, 2013 Category: Journals (General) Authors: Dimitry S. Davydow, Catherine L. Hough, Deborah A. Levine, Kenneth M. Langa, Theodore J. Iwashyna Tags: Clinical research studies Source Type: research

Vascular Risk Factors, Cardiovascular Disease, and Restless Legs Syndrome in Women
Conclusions: In this large cohort of female health professionals, various vascular risk factors are associated with the prevalence of restless legs syndrome. We could not confirm the results of previous reports indicating an association between prevalent cardiovascular disease and restless legs syndrome.
Source: The American Journal of Medicine - February 15, 2013 Category: Journals (General) Authors: Anke C. Winter, Markus Schürks, Robert J. Glynn, Julie E. Buring, J. Michael Gaziano, Klaus Berger, Tobias Kurth Tags: Clinical research studies Source Type: research