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Mortality rates in major and subthreshold depression: 10-year follow-up of a Singaporean population cohort of older adults.
CONCLUSIONS: Both major and subthreshold depression were associated with increased mortality, largely due to hazardous behaviours and physical comorbidity. Only major depression per se was independently associated with excess cardiovascular disease and stroke mortality. PMID: 27500920 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 10, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Detecting Nonvalvular Atrial Fibrillation and Anticoagulant Therapy in Cardioembolic Ischemic Stroke.
Authors: Min J, Farooq MU Abstract Nonvalvular Atrial fibrillation (NVAF) is the most common cardiac arrhythmia associated with an increase in risk of stroke and systemic thromboembolism. Strokes related to AF are associated with higher mortality, greater disability, longer hospital stays, and lower chance of being discharged home. The present review will focus on the current status of detecting NVAF and stroke prevention when there is AF. The CHA2DS2-VASc risk stratification scheme is discussed for the identification of patients who are at risk for thromboembolic stroke related to NVAF. Patient with a CHA2DS2-VASc...
Source: Postgraduate Medicine - June 9, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Empagliflozin Reduces Cardiovascular Events and Mortality in Type 2 Diabetes.
Authors: Guthrie R Abstract Review of: Zinnam, B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. New England Journal of Medicine. 2015; 373: 2117-2128. Patients were required to have a history of established cardiovascular disease, along with Type 2 Diabetes but were either not on antidiabetic therapy for the preceding 12 weeks, with a glycated hemoglobin level between 7% and 9%, or were on stable antidiabetic therapy for the preceding 12 weeks, with a glycated hemoglobin between 7.0% and 10.0%. Patients were randomized in a 1:1:1 ratio to either empagliflozin ...
Source: Postgraduate Medicine - April 6, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Long-Term Use of Ticagrelor in Patients with Prior Heart Attack: Ticagrelor Plus Aspirin Versus Aspirin Monotherapy.
Authors: Amico F, Schlesinger A, Mazzoni J Abstract Review of: Bonaca MP, Bhatt DL, Braunwald E et al. Design and rationale for the Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial. Am Heart J. 167(4), 437-444.e5 (2014). This Practice Pearl reviews the recent study Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared With Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54). It cha...
Source: Postgraduate Medicine - December 26, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Underuse of Anticoagulation in Patients with Atrial Fibrillation.
Authors: Vallakati A, Lewis WR Abstract Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Guidelines recommend anticoagulation for patients with intermediate and high stroke risk (CHA2DS2-VASc score ≥2). Underuse of anticoagulants among eligible patients remains a persistent problem. Evidence demonstrate that the psychology of the fear of causing harm (omission bias) results in physicians' hesitancy to initiate anticoagulation and results in an inaccurate estimation of stroke risk. The American Heart Association (AHA) initiated the Get With The Guidelines-AFIB (GWTG-AFIB) module in June 2013 to...
Source: Postgraduate Medicine - December 20, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Discontinuation of oral anticoagulation preceding acute ischemic stroke - prevalence and outcomes: Comprehensive chart review.
CONCLUSION: About 2.6% or 1 in every 38 of all ischemic stokes occurred after OAC discontinuation. Strokes occurring after OAC discontinuation also have higher mortality and morbidity. Our data suggest that any planned discontinuation of OAC, however brief, should be carefully considered. PMID: 26239873 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 5, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Implications for your practice: Important changes in the 2014 guideline for the management of patients with atrial fibrillation.
Authors: Littrell R, Flaker G Abstract Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia, currently affecting more than 5 million Americans. Management of patients with AF can be complex, with key strategies including selecting rhythm control versus heart rate control and reducing the patient's risk of stroke or other systemic embolization. The American Heart Association, American College of Cardiology, and Heart Rhythm Society released 2014 Guideline for the Management of Patients with Atrial Fibrillation, which outlines several new recommendations with important clinical implications. Among th...
Source: Postgraduate Medicine - April 1, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Management of atrial fibrillation: What is new in the 2014 ACC/AHA/HRS guideline?
Authors: Rajagopalan B, Curtis AB Abstract Abstract Recently, the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society published an updated guideline on the management of atrial fibrillation (AF). This document is a complete revision of the 2006 guideline. Prominent changes in the 2014 guideline include the use of the CHA2DS2-VASc score for risk stratification of stroke, recommendations on when and how to use newer oral anticoagulants for thromboprophylaxis, downgrading of the use of aspirin for thromboprophylaxis of moderate-risk patients, and the use of catheter ablation in...
Source: Postgraduate Medicine - March 11, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Assessment of upper extremity function in multiple sclerosis: review and opinion.
Authors: Kraft GH, Amtmann D, Susan E B, Finlayson M, Sutliff MH, Tullman M, Sidovar M, Rabinowicz AL Abstract Upper extremity (UE) dysfunction may be present in up to ~80% of individuals with multiple sclerosis (MS), although its importance may be under-recognized relative to walking impairment, which is the hallmark symptom of MS. Upper extremity dysfunction affects independence and can impact the ability to use walking aids. Under-recognition of UE dysfunction may result in part from limited availability of performance-based and patient self-report measures that are validated for use in MS and that can be readil...
Source: Postgraduate Medicine - November 28, 2014 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A retrospective case series of the lipid effects of switching from omega-3 fatty acid ethyl esters to icosapent ethyl in hyperlipidemic patients.
CONCLUSION: The results of this real-world retrospective analysis of 14 patients with hyperlipidemia demonstrated reductions in TG, LDL-C, TC, and non-HDL-C levels, with mixed results in HDL-C levels, after switching from OM3EE to IPE. PMID: 24977343 [PubMed - indexed for MEDLINE]
Source: Postgraduate Medicine - November 28, 2014 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Understanding the type 2 diabetes mellitus and cardiovascular disease risk paradox.
Authors: Green JB Abstract Patients with diabetes have approximately a 2-fold increase in the risk for coronary heart disease, stroke, and death from vascular causes compared with patients who do not have diabetes. Interventions targeted at modifiable risk factors, such as smoking cessation and management of hypertension and dyslipidemia, reduce the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). Paradoxically, large randomized studies have failed to conclusively show that intensively lowering glucose reduces CVD event rates in patients with T2DM, despite pathophysiologic and ...
Source: Postgraduate Medicine - November 28, 2014 Category: Internal Medicine Tags: Postgrad Med Source Type: research

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