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Effects of Anticoagulation on Low-Density Lipoprotein-Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
The study by Omelchenko et al1 concluded that, unlike the general population, low-density lipoprotein-cholesterol (LDL-C) levels were not associated with ischemic stroke risk among patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). To arrive at this conclusion, they retrospectively analyzed data of 21,229 patients with a first-time diagnosis of nonvalvular atrial fibrillation treated with DOACs categorized according to the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category, ...
Source: The American Journal of Medicine - September 28, 2021 Category: General Medicine Authors: Zeeshan H. Ismail, Zekarias T. Asnake, Joshua K. Salabei Tags: Letter 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

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

CHA2DS2-VASc Score Is Directly Associated with the Risk of Pulmonary Embolism in Patients with Atrial Fibrillation
Conclusions: CHA2DS2-VASc score is directly associated with the incidence of pulmonary embolism in atrial fibrillation.
Source: The American Journal of Medicine - January 1, 2014 Category: Journals (General) Authors: Walid Saliba, Gad Rennert Tags: Clinical research studies Source Type: research

CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation
This study aimed to evaluate the efficacy of statin treatment for atrial fibrillation prevention in elderly patients with hypertension, and to determine if comorbidity or CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack) score can predict the effectiveness of statin treatment. Methods: Patients aged ≥65 years with hypertension were identified from a National Health Insurance research database (a systemic sampling from 2000 to 2009 with a total of 1,000,000 subjects). Medical records of 27,002 patients were used in this study, in which 2400 (8....
Source: The American Journal of Medicine - January 17, 2013 Category: Journals (General) Authors: Chen-Ying Hung, Ching-Heng Lin, El-Wui Loh, Chih-Tai Ting, Tsu-Juey Wu 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

Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
Atrial fibrillation and peripheral arterial disease are two conditions associated with high risk of cardiovascular and cerebrovascular complications and mortality.1 –5 There is evidence that coexistence of both these clinical conditions can result to an additive risk of adverse events.6 Indeed, atherosclerotic vascular disease has been linked with stroke, thromboembolism and death in subjects with atrial fibrillation and has been therefore included as one of the components of risk scores, such as the CHA2DS2-VASc score (Congestive Heart failure, Hypertension Age> 75 years, DM, Stroke, Vascular disease) in order to strati...
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Antonios Vitalis, Alena Shantsila, Marco Proietti, Rajiv K. Vohra, Mark Kay, Brian Olshansky, Gregory Y.H. Lip 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

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

AFib in Special Populations
Abstract: For physicians who see and treat patients who present with AFib in routine clinical practice there are 4 important factors to understand and bear in mind when diagnosing and planning treatment strategies: age, gender, prior or incident heart failure, and underlying coronary artery disease (CAD) and acute coronary syndrome (ACS). (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This review addresses the clinical characteristics of each of these presentations in order. For all patients with AFib, of either gender or any age, the greatest risk is failure to prescrib...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: William J. French Tags: CME multimedia activities Source Type: research

Summer Syncope Syndrome Redux
The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months.
Source: The American Journal of Medicine - June 4, 2015 Category: Journals (General) Authors: Jennifer Juxiang Huang, Chirag Desai, Nirmal Singh, Natasha Sharda, Irbaz Riaz, Joseph Alpert Tags: Brief Observation Source Type: research

The Reply
The authors thank Xue et al for their interest in our article titled “Association between Anemia, Bleeding, and Transfusion with Long-Term Mortality Following Non-Cardiac Surgery.”1 We share the authors' concern about the potential for residual confounding in this observational analysis of a large single-center surgical database. The initial analysis adjusted for age, sex, race, elective vs emergency/urgent surgery, procedure type, and the individual components of the Revised Cardiac Risk Index including coronary artery disease, heart failure, stroke/transient ischemic attack, creatinine>2 mg/dL, and diabetes mellitus.
Source: The American Journal of Medicine - August 21, 2016 Category: Journals (General) Authors: Nathaniel R. Smilowitz, Jeffrey S. Berger Tags: AJM online Source Type: research

Cardiovascular Protection in the Treatment of Type 2 Diabetes: A Review of Clinical Trial Results Across Drug Classes
Patients with type 2 diabetes (T2DM) have a significantly higher risk of developing cardiovascular disease (CVD) —namely myocardial infarction, heart failure, and stroke. Despite clear advances in the prevention and treatment of CVD, the impact of T2DM on CVD outcome remains high and continues to escalate. Available evidence indicates that the risk of macrovascular complications increases with the severity o f hyperglycemia, thus suggesting that the relation between metabolic disturbances and vascular damage is approximately linear.
Source: The American Journal of Medicine - May 26, 2017 Category: General Medicine Authors: Francesco Paneni, Thomas F. L üscher Tags: Clinical research study Source Type: research

Diastolic hypotension may attenuate benefits from intensive systolic targets: secondary analysis of a randomized controlled trial
The potential for harm due to excessive lowering of diastolic blood pressure as a result of antihypertensive treatment has been discussed for several decades.1 Numerous observational studies and secondary analyses of randomized data have suggested that treating diastolic blood pressure below a certain threshold may lead to adverse outcomes, including a higher incidence of coronary events, stroke, heart failure, and all-cause mortality.1 –6 Proposed mechanisms include reduced endocardial perfusion leading to coronary events,7 or flow limiting coronary stenosis.
Source: The American Journal of Medicine - June 12, 2018 Category: General Medicine Authors: Todd C. Lee, Rodrigo B. Cavalcanti, Emily G. McDonald, Louise Pilote, James M. Brophy Tags: A Clinical Research Study Source Type: research

Take-Home Messages From the Recently Updated AHA/ACC Guidelines for Atrial Fibrillation
Atrial fibrillation and congestive heart failure (CHF) are “growth industries” in 21st-century industrial nations. The rapid growth of the geriatric population in these countries plays an important role in the ever-increasing number of patients seen with these 2 clinical entities. Patients with atrial fibrillation are seen on a daily basis in both the c linic and the hospital. The most devastating complication resulting from atrial fibrillation is cerebral arterial embolism with resultant stroke.
Source: The American Journal of Medicine - August 7, 2019 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

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