Nature reviews. Cardiology
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Abdominal aortic aneurysm (AAA) is an important health problem. Elective surgical treatment is recommended on the basis of an individual's risk of rupture, which is predicted by AAA diameter. However, the natural history of AAA differs between patients and a reliable and individual predictor of AAA progression (growth and expansion rates) has not been established. ⋯ Although studies of these markers have shown promising results, they have not yet led to a clinically applicable biomarker. In future studies, adjustment for initial AAA size, smoking history and the measurement error for determination of AAA size, among other variables, should be taken into account. A large, prospective, standardized, follow-up study will be needed to investigate multiple circulating biomarkers for their potential role in the prediction of AAA progression, followed by a study to investigate the effect of treatment on the circulating levels of biomarkers.
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Stroke risk in patients with nonvalvular atrial fibrillation increases markedly with age. although anticoagulation is more effective than antiplatelet therapy in atrial fibrillation, it tends to be underutilized in the elderly. A study by van Walraven et al. examines the influence of age on stroke prevention therapy in atrial fibrillation.
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Proton-pump inhibitors (PPIs) can alter the pharmacodynamic profile of clopidogrel and reduce its platelet-inhibitory effects. Ho and colleagues have reported that concurrent use of PPIs and clopidogrel leads to in an increase in adverse cardiovascular outcomes. In this article we discuss the clinical implications of the interaction between these two drugs.